Thoracic Aortic Aneurysm

A thoracic aortic aneurysm is defined as a localized enlargement that has a diameter that exceeds 1.5 times the normal expected diameter of the aorta at that location. Aneurysms of the thoracic aorta affect approximately 15-20,000 Americans each year, resulting in nearly 6,000 deaths.

Risk Factors for Aortic Aneurismal Disease

  • Family history of aneurismal disease
  • History of prior arterial aneurysm substantially increases risk of developing additional aneurysm
  • Personal history of atherosclerotic disease including cardiovascular or peripheral vascular disease
  • Smoking
  • Hypertension

Signs and Symptoms

The majority of patients with aneurysms of the aorta are asymptomatic; however, common symptoms associated with aortic aneurysm disease are:

  • Chest, flank, back or abdominal pain or cramping
  • Voice change, chronic cough or hoarseness (resulting from aneurysm causing traction on recurrent laryngeal nerve)
  • Distal atheroemboli to legs, feet or toes
  • Pulsatile mass in abdomen

Treatment

Traditionally thoracic aortic aneurysms have been treated by resection of the aneurysm and replacement of the aneurismal aorta with a prosthetic graft.

The invasiveness of this procedure is often too much for patients to tolerate, especially given the other major co-morbidities such as diabetes, peripheral vascular disease, chronic obstructive pulmonary disease and coronary artery disease that often affect these patients. Hence, operative mortality rates range from 8-20% and major morbidity rates are as high as 20% with conventional open surgery.

The advent of endovascular stent grafts has revolutionized the treatment of patients with thoracic aortic aneurysms allowing operative mortality rates as low as 1%. The minimally invasive nature of the endovascular approach has also resulted in a drastic reduction in the recovery period with most patients requiring only a 3-day hospital stay (compared with an average 10-day hospital stay with conventional open surgery).