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Thoracic aortic aneurysm: Optimal surveillance and treatment

Aneurysm of the thoracic aorta is less common than in the abdominal aorta, but it is clinically important because of the risk of rupture and death. Cases are often found incidentally.

Indications for surgical or endovascular repair are based on aneurysm location and risk factors for rupture such as aneurysm size, rate of growth, and assciated conditions, while medical management is also important. Surveillance with various imaging tests is critical before and after intervention to guide treatment.

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 Large study of thoracic aortic aneurysm backs guidelines

The study... is the largest to date to support the current consensus guidelines that recommend surgery for most patients with a thoracic aneurysm that is 5.5 centimeters or larger. These guidelines are specific to patients who do not have certain genetic conditions that increase their risk of experiencing an aortic aneurysm or dissection.

Articles of Interest

TEVAR: Endovascular Repair of the Thoracic Aorta

The development of thoracic endovascular aortic repair (TEVAR) has allowed a minimally invasive approach for management of an array of thoracic aortic pathologies. Initially developed specifically for exclusion of thoracic aortic aneurysms, TEVAR is now used as an alternative to open surgery for a variety of disease pathologies due to the lower morbidity of this approach. Advances in endograft technology continue to broaden the applications of this technique.

Surgical Options for Thoracic Aortic Disease

Endovascular or surgical repair is necessary when the thoracic aortic aneurysm reaches a significant size (5-6 cm or larger), which increases the risk of aortic dissection or rupture.

TEVAR vs. Open Repair of the Descending Thoracic Aorta

This study reports that open surgical repair was associated with higher early mortality than TEVAR, but the late hazard of death and risk of reintervention were lower among patients who underwent open surgical repair. However, despite the potential improved durability of open surgical repair, the initial mortality advantage of TEVAR over open surgical repair persisted until 9 years postoperatively, resulting in a significant survival benefit associated with TEVAR. Given the mortality advantage observed in patients undergoing TEVAR over open surgical repair, TEVAR appears to be the preferred treatment modality for thoracic aortic aneurysms, with additional studies indicated to determine the optimal timing of intervention.

Learning to Defuse the Aorta

When Dr. Hal Dietz arrived at Johns Hopkins University in the 1980s, he became obsessed with helping children with Marfan syndrome, a rare and often fatal disorder that can cause the aorta, the large blood vessel that carries blood from the heart, to grow and grow until it bursts. That journey has led to surprising discoveries about Marfan’s causes and a soon-to-be published clinical trial of a drug that may help its sufferers.

Management of Descending Thoracic Aorta Disease: Evolving Treatment Paradigms in the TEVAR Era

For descending thoracic aortic aneurysms, the question of when to intervene in the elective setting is critical. Maximum diameter is currently the most important clinically useful proxy for estimating rupture risk.

Thoracic Aortic Aneurysm Repair

The active treatments for TAA are open surgical aneurysm repair and endovascular stent-graft repair.

Thoracic Endovascular Aortic Repair

Thoracic endovascular aortic repair (TEVAR) is a procedure to treat an aneurysm in the upper part of your aorta. TEVAR is a minimally invasive surgery. That means it is done with a small cut (incision). With TEVAR, a device called a stent graft is used to reinforce the aneurysm. A stent graft is a metal tube covered in fabric.

Thoracic Endovascular Aortic Repair Practice in 13 Countries

TEVAR has become the primary surgical treatment modality for descending aortic pathologies, and has expanded to new patient cohorts, including the elderly.

Treatment of massive hemoptysis after thoracic aortic aneurysm repair

Massive hemoptysis after thoracic aortic aneurysm (TAA) repair is a rare but potentially lethal condition. Endovascular management is a challenging treatment option due to the complexity of culprit vessel access.

Treatment of thoracic aortic aneurysm

If there are symptoms suggesting thoracic AA expansion, surgical intervention should be considered. If the ascending thoracic aorta or aortic sinus diameter is 5.5 cm or more in an asymptomatic surgical candidate who has a degenerative thoracic AA, chronic aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer, mycotic aneurysm, or pseudoaneurysm, surgery should be performed