Thoracic Aortic Aneurysm

                               Thoracic Aortic Aneurysm

Thoracic aortic aneurysms occur far less frequently than abdominal aortic aneurysms.  The risk factors for TAA are similar to those of AAA.  Congenital risk factors include male gender, family history and connective tissue disorders such as Marfan syndrome and Ehlers-Danlos syndrome.  Acquired factors include age, smoking, hypertension, and history of other aortic or peripheral aneurysms.  The incidence of AAA for those with TAA is approximately 40%, while only 5% of those with AAA will harbor a TAA. Therefore, the thoracic aorta should be imaged at some point during the initial evaluation of an AAA.

The gold -standard modality for accurate anatomic evaluation of a TAA is a high-quality CTA. Typically, this involves a thin slice CT scan using a timed-bolus intravenous contrast enhanced technique without oral contrast from the humeral to femoral heads.

      Treatment of TAA

Patients who present with TAA have a higher burden of cardiovascular and pulmonary co-morbidities than those who present with AAA.  For intact, asymptomatic aneurysms the strongest determinant of rupture is the diameter.  The reasonable size threshold for elective repair of TAA is 6.0 centimeters. The risk of rupture and/or death at this size is 10-15% per year and justifies the risks of repair.

There is no medical treatment of thoracic aortic aneurysms.  Two treatments that are currently available include open surgical repair and endovascular repair(TEVAR).  Open surgical repair of a TAA is one of the biggest operations the human body can tolerate.  The typical surgical approach involves a thoracotomy with or without an abdominal extension depending on the location and extent of the aneurismal segment with replacement using a polyester graft.  Surgical mortality ranges from 5-10% and the risk of complications is quite significant.

Endovascular repair of thoracic aortic aneurysms has become a viable, less invasive alternative to open thoracic repair.  Endovascular treatment involves delivery of a stent graft over a guidewire and deployment above and below the aneurysm.  Success or failure is critically dependent on the anatomy of the thoracic aorta.  Mortality ranges 3-5% and major complications occur at a much lower rate than open surgical repair. This procedure offers significant advantages of improved functional outcomes over the open surgical repair.

 

 

 

Surgical Associates of Palm Beach County / Boca Care (SAPBC) is a multi-specialty surgical group practice with expertise in General, Breast, Vascular, Endovascular, Thoracic, Colon Rectal, and Surgical Oncology. Our office is located in Boca Raton Florida.

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