Thoracic Aortic Aneurysm

Diagnosis

Thoracic aortic aneurysms often do not cause symptoms, which makes them difficult to diagnose. They are frequently discovered incidentally during imaging tests done for other reasons.

Healthcare professionals may ask about your family’s medical history, as some aneurysms can run in families.

Tests

Tests to diagnose or screen for a thoracic aortic aneurysm include:

• Echocardiogram. Uses sound waves to show blood flow through the heart and aorta. A standard echocardiogram looks from outside the body, while a transesophageal echocardiogram views the aorta from inside the body if more detail is needed.
• CT scan. Produces cross-sectional X-ray images of the aorta to reveal the size and shape of an aneurysm.
• Heart MRI. Uses magnetic fields and radio waves to create images of the heart and aorta. It does not involve radiation and may be used for people needing frequent imaging.

Treatment

The goals of treatment are to stop aneurysm growth and prevent aortic rupture. Treatment depends on the aneurysm’s size and growth rate and may include:

• Regular checkups. Small aneurysms may only need medicine and periodic imaging tests, such as echocardiograms, CT scans, or magnetic resonance angiography, to monitor changes.
• Medications. Medicines help manage conditions linked to aneurysms:

• Beta blockers slow the heartbeat and lower blood pressure, which may reduce aortic widening.

• Angiotensin 2 receptor blockers (ARBs) are used if beta blockers are unsuitable or insufficient, especially in conditions like Loeys-Dietz syndrome.

• Statins help lower cholesterol and reduce the risk of artery blockages and aneurysm complications.

• Surgery or other procedures. Surgery is usually recommended for aneurysms about 5 to 6 centimeters or larger, or smaller aneurysms with a high-risk history. Options include:

• Open surgery. Removes the damaged aorta and replaces it with a graft sewn in place.

• Aortic root surgery. Removes part of the aorta and sometimes the aortic valve, replacing the removed section with a graft. Valve-sparing repair may be done if the valve is preserved.

• Endovascular aortic aneurysm repair (EVAR). A less invasive approach using small surgical cuts to place a graft via a blood vessel, typically in the groin. Regular imaging is needed afterward.

• Emergency surgery. Required for a ruptured aneurysm, this open-chest procedure is high-risk, emphasizing the importance of early detection and treatment.