Thoracic Aortic Aneurysm

What is a Thoracic Aortic Aneurysm?

A thoracic aortic aneurysm (TAA) is bulging and weakness in the wall of the aorta, the largest blood vessel in the body, located in the chest. The aorta delivers blood from the heart to the rest of the body. There are three sections of the aorta in the chest: the ascending thoracic aorta (extending up from the top of the heart's left ventricle), the aortic arch (where the artery turns towards the back and has a candy-cane curl) and the descending thoracic aorta (the back of the chest cavity). An aneurysm can occur in any of the three areas. A thoracic aortic aneurysm can burst, which can cause life-threatening uncontrolled bleeding.

Causes

Atherosclerosis (hardening of the arteries caused by a buildup of fatty substances, plaque and other elements) plays a key role in the development of all three types of thoracic aortic aneurysms: ascending thoracic aneurysm, aortic arch thoracic aneurysm and descending thoracic aneurysm.

Risk Factors

Risk factors vary depending on the type of aneurysm, though atherosclerosis is a key risk factor for all three types of TAAs.

Descending Thoracic Aneurysm

• Being older than 60
• Male gender
• Family history of TAA
• High cholesterol
• High blood pressure
• Smoking
• Diabetes
• Genetic disorders

Aortic Arch Thoracic Aneurysm

• Takayasu's arteritis (inflammation of the arteries)
• Continuation of an ascending or descending thoracic aneurysm

Ascending Thoracic Aneurysm

• Cystic medial degeneration (tissue breakdown in the aortic wall)
• Genetic disorders (such as Marfan's syndrome, Ehlers-Danlos syndrome, Turner's syndrome and polycystic kidney disease) that affect connective tissue such as bones, cartilage, heart and blood vessels
• Family history of TAA

What are the Symptoms?

• Severe or dull pain in the abdomen, chest, lower back or groin
• Sharp, sudden pain in the back or abdomen (may signal a rupturing aneurysm)

How is a Thoracic Aortic Aneurysm Diagnosed?

• Chest X-ray: X-ray pictures are taken of the chest to determine if there are any abnormalities that suggest an aortic aneurysm.
• Computed Tomography (CT) scan: X-ray slices of the aorta are taken to determine if there are any aneurysms.
• Magnetic resonance imaging (MRI) scan: Radio waves and magnetic fields are used to show areas where an aneurysm may be present.
• Angiography: Dye is injected into the arteries through a catheter, then an X-ray is taken to show how blood flows through the arteries and whether any aneurysms are present. UVA's angiography/interventional radiology suites are equipped with technology that allows for 3-D images of aneurysms to help determine the best plan of treatment.

• Echocardiogram or transesophageal cardiogram: An exam that evaluates the structure and function of the heart, arteries and other structures in the chest through sound waves. A transesophageal cardiogram is performed by inserting an ultrasound probe into the esophagus.

Treatment at UVA's Heart and Vascular Center

• Close monitoring: Regular screenings to check the size and growth of the aneurysm to determine if treatment is necessary.
• Lifestyle changes: Steps such as quitting smoking, controlling diabetes and eating a low-fat diet to reduce cholesterol may help keep the aneurysm from growing.
• Medication: Medicine to reduce cholesterol or high blood pressure.
• Surgery: Surgeons may repair the aneurysm with a stent-graft, inserted into the aorta through an artery in the leg. In some cases, open surgery (requiring a larger incision in your chest) may be necessary to repair the aneurysm by placing an artificial blood vessel into the aorta to replace the aneurysm.