What Is A Thoracic Aortic Aneurysm (TAA)
Aneurysms, developing in the thoracic aorta, which passes through the upper region of the trunk or thorax, are called thoracic aortic aneurysms.
- Pain, wheezing and coughing may result from thoracic aortic aneurysms, or they may be even asymptomatic.
- Severe pain felt at the upper back and spreading down in to the abdominal region may indicate the rupture of a thoracic aortic aneurysm.
- Presence of thoracic aortic aneurysms, when accidentally discovered, can be confirmed by further tests such as x-ray, CT scan etc.
- Surgical repair of the aneurysms is undertaken to prevent rupture.
With the more frequent use of CT scan for diagnostic purposes of other chest ailments, thoracic aortic aneurysms are getting discovered more often, making preemptive surgical repair possible. Cystic medial necrosis is a condition in which, the aortic walls degenerate and the emerging region of the aorta enlarges resulting in aortic valve dysfunction, including aortic valve regurgitation. People with Marfan syndrome are found to be more prone to this type of aneurysm. High blood pressure is the only other identifiable cause of this condition, in people without Marfan syndrome. Occasionally, syphilis infection is found to cause aneurysms in the part of aorta nearest to the heart. Blunt injuries to the chest are also found to be a risk factor for aneurysms of the thoracic aorta.
Symptoms Of Thoracic Aortic Aneurysm
Without causing any apparent symptoms or discomfort, some thoracic aortic aneurysms grow in size within the chest, till they start exerting pressure on the other internal structures. When large aneurysms exert pressure on the trachea, esophagus and larynx; symptoms such as coughing, wheezing, difficulty in swallowing food and hoarseness of voice start developing. Pain may be felt high up in the back too. Pressure on some nerves in the chest may result in Homer’s syndrome that has symptoms which appear peculiarly on one side of the face only, such as drooping of eyelid, constriction of pupil or sweating of face. Displaced wind pipe and pulsations in the chest may also result from an anurism.
A rupture results in the typical piercing and continuous pain, starting high up in the back and progressing down into the abdomen. Pain in the chest and down the arms, similar to a heart attack, may also be present. Loss of blood due to internal bleeding causes shock and finally death.
Treatment Of Thoracic Aortic Aneurysm
Pre emptive and scheduled surgery before a rupture, is the ideal solution to thoracic aortic aneurysms. Drugs to lower blood pressure and slow down the heart rate are given to minimize the risk of rupture. Either open chest surgery or endovascular stent placement is done, to repair aneurysms more than 2 inches wide. It entails a hospital stay of up to a week or more and carries a risk of death between five to ten percent. People with Marfan syndrome are subjected to surgery much earlier, considering the additional risk of early rupture. In spite of the high risk rate, surgical repair before rupture is always advisable, as the risk of death during surgery following a rupture is around 50%, even with immediate surgical intervention. Ruptured thoracic aortic aneurysms are 100% fatal, if they are not treated.
Aneurysms Of Smaller Arteries
Occasionally, coronary arteries of the heart and femoral arteries of the thigh and more commonly, popliteal arteries running at the back of the knee, also develop aneurysms but the incidence is more common among older people. The carotid arteries of the neck can also have aneurysms, but it is very rare. Weakening of the arterial walls, due to atherosclerosis or due to congenital defects, is the main cause of these aneurysms. Mechanical injuries to the arteries, bacterial and fungal infections which originate in the valves and spread to the arterial walls, are also found to be responsible for aneurysms.
Aneurysms in the femoral, coronary and popliteal arteries are generally asymptomatic and ruptures also occur rarely. But risk of clot formation and resultant emboli blocking smaller arteries are much higher. Emboli originating in the carotid aneurysms can cause a block in the smaller arteries in the brain, resulting in stroke.
When a pulsating mass is detected during physical examination, further tests such as ultrasound scan and CT scan are done, to confirm the aneurysms and to determine their size and progress. Surgical repair of aneurysms 1 inch or more in size are usually done, especially in the case of popliteal aneurysms.
Cerebral Aneurysm occurs in the cerebral arteries that supply blood in the brain. When a cerebral Aneurysm ruptures, it causes intracerebral hemorrhage or bleeding in the brain which leads to stroke. Cerebral aneurysms are usually small but they are dangerous due to their proximity to the brain and their treatment is also different. Infections in the cerebral aneurysms are promptly treated and surgical repair is done, because of the extreme danger they pose.
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Yasser Elnahas
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