Thoracic or Abdominal Aortic Aneurysm

A thoracic aortic aneurysm is an abnormal widening or ballooning of a portion of the aorta artery, related to weakness in the wall of the blood vessel. While it may be caused by a variety of conditions, including high blood pressure, congenital disorders (such as Marfan's syndrome), or trauma, atherosclerosis is by far the most common cause.

Thoracic aneurysms occur in different places in the aorta, with 50% of all cases occurring in the descending thoracic aorta and the balance either occurring in the ascending aorta or aortic arch.  Abdominal aortic aneurysms most often occur below the renal arteries before the aorta divides into the iliac arteries which supply blood to the legs.

Symptoms

Most patients have no symptoms until the aneurysm begins to leak or expand. Most non–leaking thoracic or abdominal aortic aneurysms are detected by tests, such as a chest X–ray or a CT scan, which are being run for other reasons. Chest or back pain may indicate acute expansion or leakage of the aneurysm.

Diagnostic Tools

Many tests are used to diagnose a thoracic aortic aneurysm. Usually, more than one test is required before a definitive diagnosis can be made. These tests may include: 

  • physical examination and patient history  

  • chest X–ray   

  • echocardiogram

  • chest or abdominal CT scan

  • Chest or abdominal MRI  

  • thoracic or abdominal aortic angiography   

Treatment Options

Treatment options depend on the location of the aneurysm, the diameter of the aorta where the aneurysm occurs, and patient needs, and may include:  

  • ascending aorta or aortic arch surgery

  • descending thoracic aorta

  • abdominal aortic surgery (open surgical procedure or endograft)

 
Aortic Dissection

Aortic dissection is a condition in which there is bleeding into and along the wall of the aorta (the major artery from the heart). This condition may also involve abnormal widening or ballooning of the aorta (aneurysm).

Symptoms

Patients with aortic dissection may present with one or several of the following symptoms:

  • back pain

  • chest pain

  • clammy skin

  • decreased movement, any location

  • decreased sensation, any location

  • dizziness, fainting

  • high blood pressure

  • intense anxiety, anguish

  • nausea and vomiting

  • pallor (paleness)

  • profuse sweating 

  • rapid pulse

  • shortness of breath

  • weak or absent pulse

Diagnostic Tools

Many tests are used to diagnose aortic dissection. Usually, more than one test is done before a definitive diagnosis can be made. Some of the tests may include:

  • physical examination and patient history  

  • chest X–ray   

  • echocardiogram (transthoracic or transesophageal)

  • chest or abdominal CT scan

  • chest or abdominal MRI  

  • thoracic or abdominal aortic angiography   

Treatment Options

There are many treatment options for an aortic dissection. These may include:

  • medications, such as antihypertensives, drugs to lower blood pressure, or cardiac medications such as beta–blockers  

  • Surgery

    • coronary artery bypass graft (CABG)  

    • heart valve surgery (aortic valve replacement) repair or replacement of the section of the aorta