Thoracic Aortic Aneurysm - Causes and Treatment Options

Thoracic Aortic Aneurysm

Dr.Chenniappan M profile Authored by Dr.Chenniappan M on 18 Dec 2014 - 12:32.

What is an aortic aneurysm?

Aortic aneurysm is an enlargement or bulging of an aorta (major blood vessel that is responsible for supplying pure (oxygenated) blood from the heart to other parts of the body) causing weakening of the wall of the aorta at the bulging site. The bulge (aneurysm) can be tube shaped or round shaped.

Types of Aortic aneurysms:

Abdominal aortic aneurysm- Bulging on the aorta that goes through the abdomen.

Thoracic aortic aneurysm – Bulging of the aorta going through the chest cavity.

Thoraco-Abdominal Aortic Aneurysms - Bulging in both the thoracic aorta as well as in the abdominal aorta.

A person may have any or the both of the above types of Aortic aneurysms – Abdominal or Thoracic. It is important to treat the aortic aneurysm on time, as it increases one’s risk of further tearing of inner layers of aorta(aortic dissection) thereby weakening the walls of the aorta and rupturing of the bulged part of the aorta, causing life threatening consequences. Further, surgery of a ruptured aneurysm is also life-threatening and so it becomes important to take the right treatment at the right time. 

What causes an aortic aneurysm?

  • Tobacco use
  • Prolonged infections
  • Stiffening of the arteries (Atherosclerosis)
  • Injury
  • Valve disorders and other health conditions

When is the Aortic Aneurysm surgery required?

Most often aneurysms do not produce noticeable symptoms and may not require surgery. Butwhen the patient experiences the following symptoms, surgical repair may be required:

Abdominal aortic aneurysm:

  • Constant abdominal pain
  • Back pain
  • Abnormal feeling near naval

Thoracic aortic aneurysm

  • Chest pain
  • Cough
  • Obstructed breathing
  • Difficulty in producing sound/ speaking
  • Back pain

Who is the right candidate for the surgical repair?

Considering its severe consequences and risks, the surgical repair (using a man-made graft) may be considered if:

  • The detected aneurysm is larger (≥5. 5 cm in diameter) in men.
  • Even if smaller aneurysm is detected in women.
  • Age and health conditions permit
  • If Aneurysm resulted as a genetic abnormality

What are the surgical options available?

There are two options available for the surgical repair of both the types of aortic aneurysms.

  • Open surgery
  • Endovascular repair

While selecting a right procedure for an individual, the expert may consider the factors, including age, location of the aneurysm and its size.

1. Open repair surgery

It is a traditional form of surgical repair which involves the opening of a respective part (here abdomen or chest cavity) to see the affected part (aorta) clearly and repairing it by replacing the damaged part with an artificial graft.

What can one expect from the surgery?

Before surgery:

  • If one is a smoker, he may be asked to quit for at least for 4 weeks before the planned surgery.
  • The patient may be restricted to eating or drink anything after midnight before the planned surgery.
  • Pre-operative assessments may be performed including, pulmonary test, screening of the heart, ultrasound, etc.
  • The surgery may be done under general anaesthesia.

During the surgery:

  • The blood flow to the affected area is restricted after making the incision.
  • The aneurysm will be removed and replaced with artificial graft.
  • An incision in the respective area will be closed using stitches or staples.
  • Overall, surgery may take 2 to 4 hours.

After the surgery:

  • After a few hours, patient will be shifted to the general ward after observation in the ICU (intensive care unit).
  • One may have to stay in the hospital for several days until all the health parameters are normal and recovery is noticeable.
  • The patient may experience soreness at the surgical site for a few days.
  • Weakness maybe experienced for several weeks after the surgery.
  • Recovery may be good enough to perform most of the daily activities by up to 6 weeks.Complete recovery may take about 3 months.
  • The patient may have to make frequent visits for a checkup with the surgeon to keep track of overall health.

What are the risks associated with the open surgery?

  • Increased risk of life-threatening event if the aneurysm is at its worst.
  • About 4- 8% of patients undergoing this surgery may die during the procedure or  in 30 days after the surgery.
  • Increased risk of other complications, including chronic conditions associated with heart, kidney or lungs.
  • Bleeding.
  • Surgical site infections.
  • Complications associated with colon, erection abnormalities in men, and so on.
  • Nerve damage
  • Damage to the nearby organ or area
  • Artificial graft related abnormalities.

2. Endovascular repair

It is less invasive (minimally invasive) and comparatively advanced procedure of repairing the aneurysm from the inside of the damaged the aorta.

What to expect before surgery?

  • Similar to open surgery, necessary screening tests will be performed and the patient will be prepared for the surgery.
  • All the vital health parameters like heart rate, BP, etc. will be closely monitored.
  • Local or general anesthesia may be given.

During the surgery:

  • One or two cuts will be made in the groin area.
  • A catheter (a small tube) will be inserted into the blood vessel and the dye will be injected inside to clearly see the x-ray picture.
  • With the help of a catheter, the expert will insert a stent graft inside, till it reaches aneurysm and attaches it to blood vessels.
  • The catheter will be taken out and incision is closed.
  • Finally, normal blood supply will be regulated and maintained.

After the surgery:

  • The patient may be hospitalized for about 3 days after the surgery.
  • Soreness may be experienced at the surgical site for about 1 to 2 weeks.
  • Rest is mandatory for about 2 weeks, following the surgery.
  • Complete recovery may be attained by 4 weeks after the surgery.
  • To keep track of possible complications, periodic visits to the doctor is a must.

What are the risks associated with endovascular surgical repair?

  • Infections
  • Bleeding
  • Problems associated with the graft
  • About 15% patients undergoing endovascular surgery may require additional surgeries.

What can make the aortic aneurysm surgeries complicated?

  • Having chronic diseases like cardiovascular diseases, kidney diseases, lung disease or other severe disease.
  • Age
  • Reactions to medication
  • Heart attack
  • Blood clots

What are the comparative benefits of the surgery (endovascular repair vs. open surgery)?

  • Both the surgeries outweigh the life-threatening risks like bursting of an aneurysm or tearing of the inner aortic wall.
  • Both surgeries enhance longevity, if the procedure is successful.

Add-on benefits of endovascular repair:

  • No complications of major surgery
  • Shorter recovery time
  • Shorter hospital stay
  • Low risk of life threatening events (1% of the patient may die during the surgery or after 30 days of endovascular repair).
*Disclaimer This is not medical advice. The content is for educational purposes only. Please contact your doctor for any health care issues.