Thoracic Aortic Aneurysm

What is a thoracic aortic aneurysm?

A thoracic aortic aneurysm occurs in the chest area as a part of the aorta which is the major blood vessel that supplies blood to the body. When the aorta becomes abnormally large or balloons outward, that results in an aneurysm. The aorta is the major blood vessel that supplies the blood to the body. The aorta can be divided into three segments: the ascending aorta, aortic arch and the descending aorta. An aneurysm may be in one of those areas and/or may be continuous throughout the aorta.

The experienced heart team of cardiac and vascular surgeons will review cases weekly at the Aortic Aneurysm and Dissection Clinic. This team of experts will determine the best treatment plan for each patient. Whenever possible the surgeons prefer to do the least invasive procedure possible. 

Causes of Thoracic Aneurysm

  • Age (greater than 60)
  • Male (occurrence in males is four to five times greater than that of females)
  • Family History (first degree relatives such as father or brother)
  • Genetic Factors
  • Hyperlipidemia (elevated fats in the blood)
  • Hypertension (high blood pressure)
  • Smoking
  • Diabetes

Symptoms of Thoracic Aneurysm

Some common symptoms of thoracic aneurysm are the following:

  • difficult breathing and swallowing
  • loss of consciousness 
  • low blood pressure
  • sudden and persistent chest or back pain

Diagnosis of Thoracic Aneurysm

In addition to a complete medical history and physical examination, the diagnosis of thoracic aneurysm may include any, or a combination, of a CT scan, MRI, ultrasound or arteriogram.

  • computed tomography scan (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than standard x-rays.
  • magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
  • echocardiogram (Also called echo.) - a procedure that evaluates the structure and function of the heart by using sound waves recorded on an electronic sensor that produce a moving picture of the heart and heart valves, as well as the structures within the chest, such as the lungs, mediastinum (area in the chest containing the heart, aorta, trachea, esophagus, thymus, and lymph nodes), and pleural space (space between the lungs and the interior wall of the chest).
  • transesophageal echocardiogram (TEE ) - a diagnostic procedure that uses echocardiography to assess the presence of an aneurysm, the condition of heart valves, and/or presence of a dissection (tear) of the lining of the aorta. TEE is performed by inserting a probe with a transducer on the end down the throat.
  • chest x-ray - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
  • arteriogram (angiogram) - an x-ray image of the blood vessels used to evaluate various conditions, such as aneurysm, stenosis (narrowing of the blood vessel), or blockages. A dye (contrast) will be injected through a thin flexible tube placed in an artery. The dye makes the blood vessels visible on an x-ray.

Thoracic Aneurysm Treatment

Specific thoracic aneurysm treatment will be determined by your physician based on:

  • your age, overall health, and medical history
  • extent of the disease
  • your signs and symptoms
  • your tolerance of specific medications, procedures, or therapies
  • expectations for the course of the disease
  • your opinion or preference

Thoracic Aneurysm treatment may include: 

  • routine MRI or CT - to monitor the size and rate of growth of the aneurysm
  • controlling or modifying risk factors - steps such as controlling blood pressure, quitting smoking, controlling blood sugar if diabetic, losing weight if overweight or obese, and controlling dietary fat intake may help to control the progression of the aneurysm
  • medication - to control factors such as hyperlipidemia (elevated levels of fats in the blood) and/or high blood pressure
  • surgery
    • Thoracic Endovascular Aneurysm Repair (TEVAR): TEVAR is a procedure which requires only small incisions in the groin, along with the use of x-ray guidance and specially-designed instruments, to repair the aneurysm by inserting a tube, called a stent-graft, inside the aorta. At this time, the only thoracic aneurysms repaired by means of TEVAR are descending thoracic aneurysms.
      • In 2018, Beaumont was the first hospital in Michigan to treat TEVAR patients who have smaller iliac arteries due to improvements in design of stent grafts. Prior to this improved technology, these patients would not have been a candidate for this less-invasive procedure.
    • Thoracic aortic aneurysm open repair: The type of surgical repair of a thoracic aortic aneurysm will depend on several factors: the location of the aneurysm, the type of aneurysm, and the patient's tolerance for the procedure. For an ascending or aortic arch aneurysm, a large incision may be made through the breastbone (median sternotomy). If an ascending aneurysm involves damage to the aortic valve of the heart, the valve may be repaired or replaced during the procedure. For a descending aneurysm, a large incision may extend from the back under the shoulder blade around the side of the rib cage to just under the breast (thoracotomy). These approaches allow the surgeon to visualize the aorta directly to repair the aneurysm.