A thoracic aortic aneurysm is a weakened area in the major blood vessel that feeds blood to the body (aorta). When the aorta is weak, blood pushing against the vessel wall can cause it to bulge like a balloon (aneurysm).
A thoracic aortic aneurysm is also called a thoracic aneurysm, and aortic dissection can occur because of an aneurysm. A dissection is a tear in the wall of the aorta that can cause life-threatening bleeding or sudden death. Large, fast-growing aneurysms also may rupture, but small and slow-growing aneurysms may never rupture.
Depending on the cause, size and growth rate of your thoracic aortic aneurysm, treatment may vary from watchful waiting to emergency surgery. Ideally, surgery can be planned if necessary.
Thoracic aortic aneurysms often grow slowly and usually without symptoms, making them difficult to detect. Some aneurysms will never rupture. Many start small and stay small, although some expand over time. How quickly an aortic aneurysm may grow is difficult to predict.
As a thoracic aortic aneurysm grows, some people may notice:
Aortic aneurysms can develop anywhere along the aorta, which runs from your heart through your chest and abdomen. When they occur in the chest, they're called thoracic aortic aneurysms. Aneurysms can occur anywhere in the thoracic aorta, including near the heart, in the aortic arch and in the lower part of the thoracic aorta.
Thoracic aortic aneurysms are less common than aneurysms that form in the lower part of your aorta (abdominal aortic aneurysms). An aneurysm can also occur in between the upper and lower parts of your aorta. This type of aneurysm is called a thoracoabdominal aneurysm.
Most people with aortic aneurysms don't have symptoms unless a tear or rupture occurs. A dissection or rupture is a medical emergency. Call 911 or your local emergency number for immediate assistance.
If an aneurysm ruptures or one or more layers of the artery wall tears, you may feel:
If you have a family history of aortic aneurysm, Marfan syndrome or another connective tissue disease, or a bicuspid aortic valve, your doctor may recommend regular ultrasound or radiology testing such as CT scans or MRI exams to screen for aortic aneurysm.
Factors that can contribute to an aneurysm's development include:
Genetic conditions. Aortic aneurysms in younger people often have a genetic cause. People who are born with Marfan syndrome, a genetic condition that affects the connective tissue in the body, are particularly at risk of a thoracic aortic aneurysm because they may have weakness in the aortic wall.
Marfan syndrome generally causes distinct physical traits, including tall stature, very long arms, a deformed breastbone and eye problems.
Other family-related disorders can cause an aortic aneurysm, including vascular Ehlers-Danlos, Loeys-Dietz and Turner syndromes. Vascular Ehlers-Danlos syndrome causes your skin, joints and connective tissue to be fragile and makes your skin stretch easily.
In aortic dissection, a tear occurs in the wall of the aorta. This causes bleeding into and along the aortic wall and, in some cases, completely outside the aorta (rupture).
An aortic dissection is a potential life-threatening emergency, depending on where in the aorta it occurs. It's important to treat an aortic aneurysm to try to prevent dissection. If dissection occurs, people can still be treated with surgery, but they will have a higher risk of complications.
Thoracic aortic aneurysm risk factors include:
Tears in the wall of the aorta and rupture of the aorta are the main complications of thoracic aortic aneurysm. A ruptured aortic aneurysm can lead to life-threatening internal bleeding. In general, the larger the aneurysm, the greater the risk of rupture.
Signs and symptoms that your thoracic aortic aneurysm has burst include:
Another complication of aortic aneurysms is the risk of blood clots. Small blood clots can develop in the area of the aortic aneurysm. If a blood clot breaks loose from the inside wall of an aneurysm, it can block a blood vessel elsewhere in your body, possibly causing serious complications.
Thoracic aortic aneurysms are often found during routine medical tests, such as a chest X-ray, CT scan or ultrasound of the heart, sometimes ordered for a different reason.
Your doctor will ask questions about your signs and symptoms, as well as your family's history of aneurysm or sudden death.
If your doctor thinks that you have an aortic aneurysm, imaging tests can confirm it. Tests for thoracic aortic aneurysm include:
Conditions that cause a thoracic aortic aneurysm may run in families. Your doctor may recommend screening if a first-degree relative — such as a parent, sibling, son or daughter — has Marfan syndrome or another condition that could cause a thoracic aortic aneurysm.
Tests used to screen for thoracic aortic aneurysms may include:
The goal of treatment is to prevent your aneurysm from growing and to treat it before it dissects or ruptures. Depending on the size and growth rate of your thoracic aortic aneurysm, treatment may vary from watchful waiting (monitoring) to surgery.
If your thoracic aortic aneurysm is small, your doctor may recommend imaging tests to monitor the aneurysm, along with medication and management of other medical conditions.
Usually, you'll have an echocardiogram, CT or magnetic resonance angiography (MRA) scan at least six months after your aneurysm is diagnosed, and at regular follow-up exams. How often you have these tests done depends on the cause and size of the aneurysm, and how fast it's growing.
If you have high blood pressure or blockages in your arteries, your doctor will likely prescribe medications to lower your blood pressure and cholesterol.
These medications could include:
If you smoke or chew tobacco, it's important that you quit. Using tobacco can worsen your aneurysm.
Surgery is generally recommended for thoracic aortic aneurysms about 1.9 to 2.4 inches (about 5 to 6 centimeters) and larger. If you have Marfan syndrome, another connective tissue disease, a bicuspid aortic valve or a family history of aortic dissection, your doctor may recommend surgery for smaller aneurysms due to the higher risk of aortic dissection.
Most people with a thoracic aortic aneurysm have open-chest surgery, but in some select cases your doctor may determine you're a candidate for a less invasive repair called endovascular surgery.
The type of surgery you have depends on your condition and the location of your thoracic aortic aneurysm.
If you've been diagnosed with a thoracic aortic aneurysm, your doctor will likely advise you to avoid heavy lifting and some vigorous physical activities, as these can increase blood pressure, putting additional pressure on your aneurysm.
If you want to participate in a particular activity, ask your doctor if it would be possible to perform an exercise stress test to see how much exercise raises your blood pressure. Moderate physical activity is generally healthy for you.
Stress can raise your blood pressure, so try to avoid conflict and stressful situations as much as possible. If you're going through a particularly emotional time in your life, let your doctor know because your medications may need to be adjusted to keep your blood pressure levels from going too high.
There are no medications you can take to prevent an aortic aneurysm, although taking medications to control your blood pressure and cholesterol level may reduce your risk of having complications from a thoracic aortic aneurysm.
For now the most appropriate approach to prevent an aortic aneurysm or keep an aneurysm from worsening is to keep your blood vessels as healthy as possible. This means taking certain steps, including these:
If you have some risk factors for aortic aneurysm, talk to your doctor. If you are at risk, your doctor may recommend treatment, including medications to lower your blood pressure and relieve stress on weakened arteries. You may also want to consider screening echocardiograms every few years.
Living with a thoracic aortic aneurysm can be stressful. Try to avoid stressful situations and strong emotions such as anger, as these can increase your blood pressure.
Some people with an aneurysm or related conditions may feel fear, anxiety or depression. Talk to your doctor if you experience these emotions. He or she may refer you to a psychologist.
You may find it helpful to join a support group with people who have similar conditions. Talk to your doctor about support groups in your area.
If you think you may have a thoracic aortic aneurysm or are worried about your aneurysm risk because of a strong family history, make an appointment with your family doctor. If an aneurysm is found early, your treatment may be easier and more effective.
If you're being screened for an aortic aneurysm, your doctor will likely ask if anyone in your family has ever had an aortic aneurysm, so have that information ready.
Because appointments can be brief and there's often a lot to discuss, it's a good idea to be prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.
Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For an aortic aneurysm, some basic questions to ask your doctor include:
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask additional questions during your appointment.
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
It's never too early to make healthy lifestyle changes, such as quitting smoking, eating healthy foods and getting more exercise. Taking these steps can help prevent thoracic aortic aneurysm and its complications.
If you're diagnosed with a thoracic aortic aneurysm, you should ask about the size of your aneurysm, whether your doctor has noticed any changes and how frequently you should visit your doctor for follow-up appointments.
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