Thoracic Aortic Aneurysm and Aortic Dissection

What is Thoracic Aortic Aneurysm and Aortic Dissection?

A thoracic aortic aneurysm, which is located in the chest region, is a weakened area in the wall of the aorta. This weakening causes the aorta to bulge and widen by 50 percent.

The thoracic aneurysm may be located in any of the three areas of the thoracic aorta (ascending aorta, aortic arch, and descending aorta), or it may continue through all three. The most common area to develop a thoracic aneurysm is in the descending thoracic aorta.

If the thoracic aneurysm continues down into the abdominal aorta, it is known as a thoracoabdominal aneurysm. Thoracic aneurysms occur less frequently than abdominal aneurysms. 

The shape types of an aneurysm are fusiform or saccular. A fusiform aneurysm bulges out on both sides of the aorta while a saccular aneurysm bulges only on one side.

With each heartbeat, the walls of the aorta expand and then come back as blood is pumped through it. This continuing pressure on a weak wall in the area of an aneurysm can cause the wall to rupture. It may also lead to dissection, which is the separation of the layers of the aortic wall. Either case may cause life-threatening hemorrhaging. 

At Yale Vascular Surgery, we offer the widest range of treatment and management options for thoracic aortic aneurysm. In addition to being well-versed with the traditional or classic techniques and surgeries, many additional procedures offered by our innovative surgeons are at the leading edge of vascular surgery. Our multidisciplinary vascular team works collectively to create personalized treatment plans that provide the best options for each patient, reflecting his or her specific condition and individual needs.

Causes of Thoracic Aortic Aneurysm and Aortic Dissection

A thoracic aortic aneurysm may be caused by different disease processes and typically corresponds with the location of the aneurysm. 

Below is a list of causes based on the aneurysm’s location. 

Ascending Thoracic Aneurysm

  • Necrosis (a breaking down of the aortic wall tissue) 
  • Genetic disorders that affect connective tissue, such as Marfan syndrome 
  • A family history without genetic disorders
  • Atherosclerosis
  • Infections that affect the aorta, such as syphilis

Aortic Arch Thoracic Aneurysm

  • Takayasu's arteritis (a type of vasculitis that causes inflammation of the arteries)
  • Atherosclerosis
  • Continuation of an ascending and/or descending aortic aneurysm

Descending Thoracic Aortic Aneurysm

Atherosclerosis is most often associated with descending thoracic aneurysms.

Symptoms of Thoracic Aortic Aneurysm and Aortic Dissection

Thoracic aortic aneurysms may or may not produce symptoms. Symptoms of a thoracic aneurysm may be related to the location, size, and growth rate of the aneurysm.

Symptoms of a thoracic aneurysm may include: 
  • Pain in the jaw, neck, and/or upper back
  • Pain in the chest and/or back
  • Wheezing, coughing, or shortness of breath as a result of pressure on the trachea (windpipe)
  • Hoarseness as a result of pressure on the vocal cords
  • Difficulty swallowing (dysphagia) due to pressure on the esophagus
Having one or more of the above symptoms does not mean that you have a thoracic aortic aneurysm. This list should be used as a guideline only. If you are experiencing one or more of the above symptoms, please call your doctor.


Risk Factors of Thoracic Aortic Aneurysm and Aortic Dissection

At Yale Vascular Surgery, we emphasize patient education, risk-factor reduction, and management. Knowing your risk factors for any disease can help to guide you to the appropriate actions, including changing certain behaviors and being clinically monitored for the disease.

The following factors are associated with an increased risk in developing aneurysmal disease: 
  • Age: patients older than 60 are at an increased risk
  • Gender: males have a four to five times greater risk of developing the disease 
  • Family history 
  • Genetics
  • Hyperlipidemia (elevated levels of fats in the blood)
  • Hypertension (high blood pressure)
  • Smoking
  • Diabetes
It is important to understand that having one or more risk factors does not mean that you will develop the disease. The information should be used only as a guideline. 

Diagnosing Thoracic Aortic Aneurysm and Aortic Dissection

If you think you have an aneurysm, it is important to get a diagnosis so that you can begin treatment and management of the disease to prevent rupturing.

Yale Vascular Surgery uses the most innovative techniques to diagnose vascular conditions so that you can receive a timely and accurate diagnosis. In addition to using diagnostic procedures, our surgeons take the time to discuss your medical history and perform a physical examination.

Below describes the most common diagnostic procedures:
Computed Tomography (CT) Scan
A CT scan is an imaging procedure combining X-rays and computer technology to produce cross-sectional images (often called slices) of the body. A CT scan shows detailed images of the blood vessels. 

Magnetic Resonance Imaging (MRI)
An MRI is an imaging procedure that uses a combination of large magnets, radio frequencies, and a computer to produce detailed images of the blood vessels within the body.

Echocardiogram (also called Echo)
An echocardiogram uses sound waves to produce a moving image of the heart and its valves, as well as structures within the chest. 

Transesophageal Echocardiogram (TEE)
A transesophageal echocardiogram is an echocardiogram that is performed by inserting a probe with a transducer down the esophagus (throat). It is used to diagnose the presence of a dissection (tear) of the lining of the aorta. 

Chest X-ray
A chest X-ray uses invisible X-rays to produce images of internal tissues onto film. 

Arteriogram (Angiogram)
An arteriogram is an X-ray image of the blood vessels. A dye is injected into the artery through a thin, flexible tube. This dye makes the blood vessels visible on the X-ray.

Treatment of Thoracic Aortic Aneurysm and Aortic Dissection

Aneurysms can continue to increase in size, which can contribute to the weakening of the aortic wall. Treatment may include management of the disease and/or surgery. Preventing rupture of an aneurysm is the primary goal.

At Yale Vascular Surgery, our team includes nationally renowned surgeons who are dedicated to helping patients affected by vascular disease and who have continually excelled in caring for patients with thoracic aortic aneurysms. They will help determine the best-possible comprehensive treatment by using the latest technology and compassionate care.

Should you require surgery, our surgeons will review your surgical plan with you, in detail, so that you know what to expect before, during, and after the surgery.

Each patient’s specific treatment is determined by a number of factors, including:
  • Age
  • Overall health and medical history
  • Extent of the disease
  • Signs and symptoms
  • Patient’s tolerance of medications, procedures, or therapies
  • Expectations for the course of the disease
  • Patient’s preference

Management of an Aneurysm

The management of a thoracic aortic aneurysm may include monitoring the aneurysm with routine ultrasounds, modifying outstanding risk factors, such as quitting smoking or changing your diet, and medications that can control possible risk factors, such as high blood pressure and diabetes. 

Surgery for an Aneurysm
When surgery is necessary, the two primary options include endovascular aneurysm repair (EVAR), which is also known as Endovascular Stent Repair, and open surgery. 

Endovascular Aneurysm Repair (EVAR), or Endovascular Stent Repair
EVAR is a minimally invasive procedure that requires only small incisions in the groin. Using an X-ray for visual guidance and specially designed instruments, surgeons repair the aortic wall with a stent-graft. The stent-graft is inserted through the femoral artery and moved into the aorta to the aneurysm.

A stent-graft uses a stent, which is a long cylinder-like tube made of thin, metal mesh framework and a graft, which is made of different materials. The stent is used to hold the graft open and in place. 

Thoracic Aortic Aneurysm Open Repair
All open surgeries require an incision, but the type of repair or replacement performed will depend on the location of the aneurysm, the type of aneurysm, and the patient's tolerance for the procedure.