Thoracic Aortic Aneurysm

  1. Thoracic Aortic Aneurysm
  2. Diagnosis
  3. Surgical management
  4. Ascending aortic arch aneurysms
  5. Transverse aortic arch aneurysms
  6. Descending Thoracic Aortic Aneurysm
  7. Thoracoabdominal aneurysms
  8. Endovascular management of thoracic aortic aneurysm

Thoracic Aortic Aneurysm are primarily a disease of the elderly. Ascending and transverse arch aneurysms each comprise 25% of Thoracic Aortic Aneurysm (). The remaining 50% occur in the descending aorta (thoracic or thoracoabdominal). Most descending begin just distal to the left subclavian artery.

Pathophysiology. are divided into five main types: ascending, transverse, descending, thoracoabdominal, and traumatic. Ascending aortic aneurysms are usually caused by medial degeneration. Transverse, descending, and thoracoabdominal aortic aneurysms are related to atherosclerosis. Hypertension contributes to their expansion.

Diagnosis

  • Clinical manifestations are usually absent; most nontraumatic are detected as incidental findings on chest films obtained for other purposes. A minority of patients may present with chest discomfort or pain that intensifies with aneurysm expansion or rupture, aortic valvular regurgitation, congestive heart failure, compression of adjacent structures (recurrent laryngeal nerve, left-main-stem bronchus, esophagus, superior vena cava, porta hepatis), erosion into adjacent structures (esophagus, lung, airway), or distal embolization.
  • Radiologic evaluation. Chest films may reveal a widened mediastinum or an enlarged calcific aortic shadow. Traumatic aneurysms may be associated with skeletal fractures. MR or CT scanning with intravenous contrast provides precise estimation of the size and extent of these aneurysms and facilitates the planning of surgical therapy. Echocardiography is useful in evaluating aneurysms involving the aortic arch. Aortography demonstrates the proximal and distal extent of the aneurysm and the vessels arising from it.