Aneurysm is an abnormal enlargement or swelling of part or all of the aorta, resulting from weakness in the blood vessel wall. A thoracic aortic aneurysm occurs in the part of the body's largest blood vessel (aorta) that passes through the chest.
The most common cause of thoracic aortic aneurysm is hardening of the arteries (atherosclerosis). This condition is more common in people with high cholesterol, long-term high blood pressure , or long-term smokers.
Other risk factors for thoracic aneurysm include:
- Age
- Connective tissue diseases such as Marfan Syndrome
- Inflammation of the aorta
- Injuries resulting from falls or motor vehicle accidents
- Syphilis
Tell your doctor if you have:
- Family history of connective tissue disorders (such as Marfan Syndrome)
- Recurrent chest or back pain
Diagnostic
Aneurysms occur slowly over years. Most patients have no symptoms until the aneurysm begins to leak or enlarge. Aneurysms are often discovered accidentally during radiological examinations for diagnostic purposes of other diseases.
Symptoms will appear suddenly when:
- The aneurysm enlarges rapidly
- The aneurysm tears (called a rupture)
If an aneurysm presses on surrounding structures, the following symptoms may occur:
- Hoarseness
- Difficulty swallowing
- Swelling in the neck
Other symptoms may include:
- Chest or upper back pain
- Skin often or quickly becomes moist
- Nausea and vomiting
- Fast heartbeat
Most thoracic aortic aneurysms are detected through diagnostic tests performed for other reasons, usually a chest x-ray, echocardiogram, chest CT scan or MRI. A chest CT scan shows the size of the aorta and the exact location of the aneurysm. Aortography can identify aneurysms and aortic branches that may be involved.
Also read: Detection of Blood Vessel Abnormalities with DSA Examination
Governance
There is a risk that the aneurysm may open (rupture) if you do not have surgery to repair it.
Treatment depends on the location of the aneurysm. The aorta consists of three parts:
- The first part moves up towards the head. It's called the ascending aorta.
- The middle part is curved. It is called the aortic arch.
- The last part moves down, towards the feet. It's called the descending aorta.
For patients with aneurysms of the ascending aorta or aortic arch:
- Surgery to replace the aorta is recommended if the diameter of the aneurysm is greater than 5 - 6 centimeters.
- An incision is made in the middle of the sternum.
- The aorta is replaced with a prosthetic graft
- This is a very major operation that requires a heart-lung machine.
For patients with descending thoracic aorta aneurysm:
- Major surgery is performed to replace the aorta with a prosthetic graft if the aneurysm is larger than 6 centimeters.
- This operation is performed through an incision on the left side of the chest, which may reach into the abdomen.
Intervention Management
Endovascular stenting is a minimally invasive treatment option compared to open aortic surgery. A stent is a small metal tube used to keep an artery open. Stents can be placed into the body without making an incision in the chest. However, not all patients with descending thoracic aorta aneurysms are candidates for stenting.
Prognosis
The long-term prognosis for patients with a thoracic aortic aneurysm depends on other medical problems, such as heart disease , high blood pressure, and diabetes that may have caused or contributed to the aneurysm.
Complications
Complications in aortic surgical management can include:
- Bleeding
- Graft infection
- Heart infarction
- Arrhythmia/heart rhythm disturbance
- Impaired kidney function
- Paralysis/limb paralysis
- Strokes
Postoperative mortality occurs in 5 - 10% of patients and complications after aneurysm stenting include damage to the blood vessels supplying the leg, which may still require another operation.
TEVAR method for treating enlarged aortic blood vessels.
Minimally Invasive Surgical Technique which is carried out interventionally by inserting a catheter containing a stent/ring through a small incision in the groin into the main blood vessel of the aorta or what is known as a stent graft technique.
This device is made of a metal mesh coated with a very strong material, which aims to cover the main blood vessel of the aorta that has widened ("aneurysm") or even ruptured (rupture or "dissection") and helps keep it stable in its function of delivering blood properly to the whole body.
This device will repair the aorta and help keep it open and allow blood to flow properly throughout the body.
EMC Alam Sutera Hospital has successfully implemented the Tevar Method with a team of doctors who are experienced and competent in their fields.
Article written by dr. Achmad Faisal, Sp.BTKV, Subsp. T(K) (Thoracic, Cardiac, Vascular Surgeon Specialist, Thoracic Sub-specialist, Consultant at EMC Alam Sutera Hospital).