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Find out what a Thoracic aortic aneurysm (TAAD) is, what are symptoms, causes, diagnosis, and how it can be treated.
What is Thoracic aortic aneurysm?
Thoracic aortic aneurysm is a weakened area of the aorta which is the major blood vessel that feeds blood to the body. It is also called thoracic aneurysm and aortic dissection (TAAD) because an aneurysm can lead to a tear in the artery wall (dissection) that can cause life-threatening bleeding. Large, fast-growing aneurysms may rupture, but small and slow-growing thoracic aortic aneurysms may not ever rupture.
What is Thoracoabdominal aneurysm?
The aneurysm that occurs between the upper and lower parts of your aorta is called a thoracoabdominal aneurysm. It co-exists in both segments of the thoracic aorta and abdominal aorta.
Types of thoracic aortic aneurysm (TAA)
The following are the three groups of Thoracic aortic aneurysm depending on location:
- Ascending aortic aneurysms
- Aortic arch aneurysms
- Descending thoracic aneurysms or thoracoabdominal aneurysms
Signs and symptoms of thoracic aortic aneurysm:
Thoracic aortic aneurysms symptoms are difficult to detect because they grow slowly and usually without symptoms, making them difficult to detect. Many start small and stay small but will expand over time. It is difficult to predict, how quickly an aortic aneurysm may grow?
- Sudden, intense and persistent chest or back pain
- Pain that radiates to your back
- Trouble breathing
- Low blood pressure
- Loss of consciousness
- Shortness of breath
- Trouble swallowing
- Weakness or paralysis of one side of the body, difficulty speaking, or other signs of stroke
- Blood clot risk.
Some of the Symptoms of Thoracic Aortic Aneurysm or TAAD Include:
- Pain or tenderness in the chest.
- Pain in the back.
- Shortness of breath.
Serious Thoracic Aortic Aneurysm Symptoms Indicating the Rupture of Aneurysm Include:
- Sudden, sharp pain in the upper back which radiates downwards.
- Pain in the chest, jaw, neck or arms.
- Breathing difficulties.
What Causes a Thoracic aortic aneurysm?
Thoracic aortic aneurysm can affect different disease processes and especially in respect to their location.
Ascending thoracic aneurysm causes
- Cystic medial degeneration (necrosis) – Breaking down of the tissue of the aortic wall.
- Genetic disorders which affect the connective tissue, such as Marfan syndrome and Ehlers-Danlos syndrome
- Family history of thoracic aortic aneurysm with no incidence of Marfan syndrome
- Atherosclerosis – Hardening of the arteries caused by a build-up of plaque in the inner lining of an artery.
- Infection, syphilis (rare causes of thoracic aortic aneurysm)
- Aortic arch thoracic aneurysm causes
- Takayasu’s arteritis – A type of vasculitis that causes inflammation of the arteries
- Continuation of an ascending and/or descending aortic aneurysm
Descending thoracic aortic aneurysm causes
Atherosclerosis is associated with descending thoracic aneurysms and plays an important role in Aneurysmal disease, including the risk factors associated with atherosclerosis such as:
- Age (greater than 55)
- Male gender
- Family history (first-degree relatives such as father or brother)
- Genetic factors
- Hyperlipidemia (elevated fats in the blood)
- Hypertension (high blood pressure)
Risk factors of Thoracic aortic aneurysm
Thoracic aortic aneurysm risk factors include:
- Age: Thoracic aortic aneurysms occur most often in people age 65 and older.
- Tobacco use: Tobacco use is a strong risk factor for the development of an aortic aneurysm.
- High blood pressure: Increased blood pressure damages the blood vessels in the body, raising your chances of developing an aneurysm.
- Buildup of plaques in your arteries (atherosclerosis): The buildup of fat and other substances that can damage the lining of a blood vessel (atherosclerosis) increases your risk of an aneurysm.
- Family history: People who have a family history of an aortic aneurysm are at increased risk of having one because they tend to develop aneurysms at a younger age and are at higher risk of rupture.
- Marfan syndrome and related disorders: If you have Marfan syndrome or related disorders, such as Loeys-Dietz syndrome or Ehlers-Danlos syndrome, you have a significantly higher risk of a thoracic aortic aneurysm.
- Bicuspid aortic valve: Nearly half of those who have an aortic valve with two cusps instead of three (bicuspid aortic valve) may develop an aortic aneurysm.
Complications of Thoracic aortic aneurysms
Tears in the wall of the aorta and rupture of the aorta are the main complications of the thoracic aortic aneurysm because they can lead to life-threatening internal bleeding. The larger the aneurysm, the greater will be the risk of rupture.
Is a thoracic aortic aneurysm serious?
A thoracic aortic aneurysm is a serious health risk because it may rupture or dissect (tear), causing life-threatening internal bleeding. A thoracic aortic aneurysm can be repaired with surgery or other less invasive techniques if detected in time.
Small aneurysms place one at increased risk for:
- Atherosclerotic plaque (fat and calcium deposits) formation at the site of the aneurysm
- A clot (thrombus) may form at the site and dislodge, increasing the chance of stroke Increase in the aneurysm size, causing it to press on other organs, causing pain
- Aortic dissection or tearing of the layers of the aorta, a potentially fatal complication, and a medical emergency.
- Aneurysm rupture, because the artery wall thins at this spot, it is fragile and may burst under stress.
- A sudden rupture of an aortic aneurysm may be life-threatening and is a medical emergency
When to see a doctor?
In many cases, aortic aneurysms do not have symptoms. However, rupture or dissection which occurs in some cases is a medical emergency. Call 911 for immediate assistance.
During rupture or dissection, you may feel.
- Sharp, sudden pain in the upper back that radiates downward
- Pain in your chest, jaw, neck or arms
- Difficulty breathing
Your doctor may recommend a regular ultrasound or radiology testing including computerized tomography (CT) scan or magnetic resonance imaging (MRI) exams to screen for aortic aneurysm.
Diagnosis of Thoracic aortic aneurysms
If your doctor suspects that you have an aortic aneurysm, he may perform the following tests to confirm it. These tests might include:
- Computed tomography scan (also called a CT or CAT scan)
- Magnetic resonance imaging (MRI)
- Echocardiogram (also called echo)
- Transesophageal echocardiogram (TEE)
- Chest X-ray
- Arteriogram (angiogram)
Treatment of Thoracic aortic aneurysms
Treatment options for thoracic aortic aneurysm include monitoring or intervention, which usually involves surgery. Depending on the size of the Aortic Aneurysm and how fast it’s growing, your doctor’s will make a decision.
Your doctor may recommend medication, monitoring with imaging if your symptoms are small. He also recommends management of other medical conditions that could worsen your aneurysm. He may also ask you about any new family health issues such as aneurysm.
It’s likely that your doctor will:
- Order regular imaging tests to check on the size of your aneurysm
- Expect to have an echocardiogram, CT scan or magnetic resonance angiography (MRA)
Regular follow-up exams will be conducted at least for 6 months. The frequency of your imaging tests depends on the cause and the size of your aneurysm.
Thoracic Aortic Aneurysm Surgery
Your doctor may recommend surgery, depending on your condition and the location of your thoracic aortic aneurysm:
- Open-chest surgery: It involves removing the damaged section of the aorta and replacing it with a synthetic tube (graft), which is sewn into place. It may take a month or more to fully recover.
You may have valve-sparing aortic root repair. During this surgery, your surgeon replaces the enlarged section of the aorta with a graft whereas the aortic valve remains in place.
- Endovascular surgery: It involves attachment of a synthetic graft to the end of a thin tube (catheter) that’s inserted through an artery in your leg and threaded up into your aorta. The graft inserted reinforces the weakened section of the aorta in order to prevent rupture of the aneurysm.
Recovery time is faster when compared with open-chest surgery. Discuss with your doctor about this procedure. However, you need to have regular follow-up imaging scans in order to ensure that the graft isn’t leaking. It is the best treatment in case of abdominal aortic aneurysms.
- Other heart surgeries: Your doctor may recommend additional surgeries to repair or replace the damaged valves to stop your aneurysm from worsening, if another condition is contributing to your aneurysm’s development like heart’s valve problems. Your doctor may recommend regular monitoring of your condition, after the surgery.
- Emergency surgery: Doctors prefer to identify and treat thoracic aortic aneurysms before they rupture. They follow through with lifelong monitoring and appropriate preventive surgery.
Get ready for your appointment
If you are at a risk of thoracic aortic aneurysm or worried about your aneurysm risk because of a strong family history then get ready for your appointment with your family doctor. This is because early detection of aneurysm will result in easier and effective treatment.
Prepare yourself for the appointment:
Have a glance at all the pre-appointment restrictions and be sure to ask if there’s anything you need to do in advance, such as restrict your diet at the time of appointment.
- Write down any symptoms you’re experiencing along with the symptoms unrelated to a thoracic aortic aneurysm.
- Write down key personal information such as family history of heart disease, aneurysms or connective tissue disease.
- Make a list of all medications, vitamins or supplements that you take.
- Take a family member or friend along, if possible because it can be difficult to recall all of the information provided to you during an appointment.
- Be prepared to discuss your diet, exercise habits and tobacco use
- Be sure to tell your doctor if you have a habit of smoking
- Send imaging reports to your doctor in advance and bring your reports and medical records.
- Write down questions to ask your doctor
Questions to your doctor:
Preparing a list of questions from most important to least important in case time runs out will help you make the most of your time together. Here are some of the basic questions to ask your doctor:
- What’s the most likely cause of my symptoms?
- What kinds of tests will I need to confirm a thoracic aortic aneurysm?
- What treatments are available, and which do you recommend for me?
- What’s an appropriate level of physical activity?
- Do I need to change my diet?
- How often should I be screened for an aneurysm?
- Should I tell other family members to be screened for an aneurysm?
- How can I best manage the other health conditions together?
- Is there a generic alternative to the medicine you’re prescribing me?
- Are there any brochures or other printed material that I can take home with me?
- What websites do you recommend visiting for more information?
What to expect from your doctor?
Your doctor will ask questions after analyzing your symptoms and Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask you the following questions:
- When did you first begin experiencing symptoms?
- Do your symptoms come and go, or do you have them all the time?
- How severe are your symptoms?
- Do you have a family history of aneurysms or other hereditary diseases, such as Marfan syndrome?
- Have you ever smoked?
- Have you ever been told you have high blood pressure?
- Does anything seem to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
Facts about Thoracic aortic aneurysms
- Individuals aged 65 and above are at increased risk for developing thoracic aortic aneurysms.
- Individuals using tobacco are at higher risk for the development of an aortic aneurysm.
- Hypertension (high blood pressure) damages the blood vessels and increases the chances of developing an aneurysm.
- Atherosclerosis, which is hardening of arteries due to buildup of plaques, damages the lining of the blood vessel and increases the risk of an aneurysm.
- People with family history of aortic aneurysm are at increased risk of having one and these individuals also tend to develop aneurysms at a younger age and are at increased risk of rupture.
- Individuals with connective tissue disorders (Marfan syndrome, Ehlers-Danlos syndrome) are at a significantly higher risk for developing thoracic aortic aneurysm.
Lifestyle and Home Remedies for Thoracic Aortic Aneurysm or TAAD
- Patient should avoid heavy lifting and vigorous physical activities.
- Patient should avoid stress and try to stay calm by doing meditation.
- Patient should quit using tobacco products.
- Always try to keep blood pressure under control.
- Do regular exercises daily.
Make dietary changes by reducing cholesterol and fat intake.