Thoracic Aortic Aneurysm

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A thoracic aortic aneurysm (TAA) is an abnormal bulge that occurs in the wall of the upper portion of the aorta, which carries blood from your heart to the rest of your body. Aortic aneurysms can occur anywhere in your aorta and may be fusiform (tube-shaped) or saccular (round). An aortic aneurysm may increase the risk of aortic dissection, which occurs when a tear develops in the inner layer of the aortic wall and causes one or more of the layers of the wall to separate. There is also the risk that an aortic aneurysm can rupture. Small and slow-growing thoracic aortic aneurysms may not ever rupture, but large, fast-growing aneurysms have a higher risk of rupturing. Depending on the cause, size and growth rate, treatment may vary from monitoring the condition to emergency surgery. A surgery may be planned, if necessary.

Symptoms

As a TAA grows, patients may experience:

• Tenderness or chest pain 
• Back pain
• Hoarseness
• Cough
• Shortness of breath

Aneurysms can occur anywhere in the thoracic aorta, including the ascending aorta near the heart, the aortic arch in the curve of the thoracic aorta, and the descending aorta in the lower part of the thoracic aorta.

Causes

Many factors contribute to the development of a thoracic aneurysm, such as:

• Atherosclerosis (hardening of the arteries) → Accumulation of plaque on the walls of arteries reduces flexibility, and additional pressure can cause an aneurysm. High blood pressure and high cholesterol are risk factors for atherosclerosis and it is more common in older people.

• Aortic valve issues → Patients born with a bicuspid aortic valve, meaning the aortic valve has only two cusps instead of three, may be at a higher risk of developing a TAA.

• Genetic conditions → Aortic aneurysms in younger people often occurs in patients born with Marfan syndrome, a genetic condition that affects the body's connective tissue. Besides Marfan syndrome, Ehlers-Danlos, Loeys-Dietz and Turner syndromes, and other family-related disorders can cause an aortic aneurysm.
   
• Other medical conditions → Inflammatory conditions, such as giant cell arteritis and Takayasu arteritis, may cause TAAs.

• Untreated infection → Although rare, it is possible to develop a TAA if a patient has suffered from an untreated infection, such as syphilis or salmonella.

• Traumatic injury → Rarely, some patients who suffer injuries in falls or motor vehicle crashes can develop TAA.

Risk Factors

Thoracic aortic aneurysm risk factors include:

• Age → TAAs occur most often in people ages 65 and older.

• Tobacco use → Tobacco use is a strong risk factor for the development of TAA.

• High blood pressure → Increased blood pressure can damage the body's blood vessels and increase the risk of developing an aneurysm.

• Atherosclerosis (hardening of the arteries) → The buildup of plaques in the lining of the blood vessel increases your risk of an aneurysm. 

• Family history → Patients with a family history of aortic aneurysms have an increased the risk of developing TAA, tend to develop aneurysms at a younger age, and are at higher risk of rupture.

• Marfan syndrome and related disorders → Patients with Marfan syndrome or related disorders, such as Loeys-Dietz syndrome or Ehlers-Danlos syndrome, have a significantly higher risk of developing a TAA.

• Bicuspid aortic valve → Nearly half of patients born with a bicuspid aortic valve may develop an aortic aneurysm.

Minimally Invasive Treatment Options

• Mini-Sternotomy
• Frozen Elephant Trunk

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