Thoracic Aortic Aneurysm: How to Counsel, When to Refer (2022)

By Frank Cikach, MD; Milind Y. Desai, MD; Eric E. Roselli, MD; Vidyasagar Kalahasti, MD; and Lars G. Svensson, MD, PhD

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This post is excerpted and adapted from a recent review article in Cleveland Clinic Journal of Medicine (2018[June];85:481-492), focusing on that article’s discussion of management of thoracic aortic aneurysm following diagnosis and classification. The full article, which includes a couple of illustrative case vignettes, is freely available at this link.

How is thoracic aortic aneurysm managed on an outpatient basis?

Patients with a new diagnosis of thoracic aortic aneurysm should be referred to a cardiologist with expertise in managing aortic disease or to a cardiac surgeon specializing in aortic surgery, depending on the initial size of the aneurysm.

Medical management for patients with a thoracic aortic aneurysm has historically been limited to strict blood pressure control aimed at reducing aortic wall stress, mainly with beta-blockers.

(Video) Thoracic aortic aneurysms | Circulatory System and Disease | NCLEX-RN | Khan Academy

Current guidelines recommend stringent blood pressure control and smoking cessation for patients with a small aneurysm not requiring surgery and for those who are considered unsuitable for surgical or percutaneous intervention (evidence level C).1 For patients with thoracic aortic aneurysm, it is considered reasonable to give beta-blockers. Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers may be used in combination with beta-blockers, titrated to the lowest tolerable blood pressure without adverse effects (evidence level B).1

The recommended target blood pressure is less than 140/90 mm Hg, or 130/80 mm Hg in those with diabetes or chronic kidney disease (evidence level B).1 However, we recommend more stringent blood pressure control: i.e., less than 130/80 mm Hg for all patients with aortic aneurysm and a heart rate goal of 70 beats per minute or less, as tolerated.

Activity restriction

Activity restrictions for patients with thoracic aortic aneurysm are largely based on theory and empirical experience, and certain activities may require more modification than others. For example, heavy lifting should be discouraged, as it may increase blood pressure significantly for short periods of time.1,2 The increased wall stress, in theory, could initiate dissection or rupture. Patients with aortic dissection are often noted to have performed activities associated with straining, particularly involving rapid upper chest rotation, such as in tennis, golf, swinging an ax, throwing rocks, etc. However, moderate-intensity aerobic activity — such as jogging, cycling, walking, etc. — is rarely associated with significant elevations in blood pressure and should be encouraged. Stressful emotional states have been anecdotally associated with aortic dissection; thus, measures to reduce stress may offer some benefit.2

While there are no published guidelines regarding activity restrictions in patients with thoracic aortic aneurysm, we use a graded approach based on aortic diameter:

  • 0 to 4.4 cm — lift no more than 75 to 100 pounds
  • 5 to 5 cm — lift no more than 50 to 60 pounds
  • 5 cm — lift no more than 25 to 40 pounds

We also recommend not lifting anything heavier than half of one’s body weight and to avoid breath-holding or performing the Valsalva maneuver while lifting. Although these recommendations are somewhat arbitrary, based on theory and a large clinical experience at our Aorta Center, they seem reasonable and practical.

Activity restrictions should be stringent and individualized in patients with Marfan, Loeys-Dietz or Ehlers-Danlos syndromes due to increased risk of dissection or rupture even if the aorta is normal in size.

We sometimes recommend exercise stress testing to assess the heart rate and blood pressure response to exercise, and we are developing research protocols to help tailor activity recommendations.

When should a patient be referred?

To a cardiologist at the time of diagnosis. As soon as thoracic aortic aneurysm is diagnosed, the patient should be referred to a cardiologist who has special interest in aortic disease. This will allow for appropriate and timely decisions about medical management, imaging, follow-up and referral to surgery. Additional recommendations for screening of family members and referral to clinical geneticists can be discussed at this juncture. Activity restrictions should be reviewed at the initial evaluation.

(Video) Does Your Aortic Aneurysm Need Surgery?

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To a surgeon relatively early. Size thresholds for surgical intervention are discussed below, but one should not wait until these thresholds are reached to send the patient for surgical consultation. It is beneficial to the state of mind of a potential surgical candidate to have early discussions pertaining to the area of concern and the types of operations available, their outcomes, and associated risks and benefits. If a patient’s aortic size remains stable over time, he or she may be followed by the cardiologist until a significant size has been reached or growth has been documented, at which time the patient and surgeon can reconvene to discuss options for definitive treatment.

To a clinical geneticist. If one or more first-degree relatives of a patient with thoracic aortic aneurysm or dissection are found to have aneurysmal disease, referral to a clinical geneticist is very important for genetic testing for multiple genes that have been implicated in thoracic aortic aneurysm and dissection.

When should an aneurysm be repaired?

Surgery to prevent rupture or dissection remains the definitive treatment of thoracic aortic aneurysm when size thresholds are reached, and symptomatic aneurysm should be operated on regardless of the size. However, rarely are thoracic aneurysms symptomatic unless they rupture or dissect. The size criteria are based on underlying genetic etiology, if known, and on the behavior and natural course of the aneurysm.

Size and other factors. Treatment should be tailored to the patient’s clinical scenario, the site of the aneurysm, family history and the estimated risk of rupture or dissection, balanced against the individual center’s outcomes of elective aortic replacement.3

For example, young and otherwise healthy patients with thoracic aortic aneurysm and a family history of aortic dissection (who may be more likely to have connective tissue disorders such as Marfan syndrome, Loeys-Dietz syndrome or vascular Ehler-Danlos syndrome) may elect to undergo repair when the aneurysm reaches or nearly reaches the diameter of that of the family member’s aorta when dissection occurred.1 On the other hand, an aneurysm of degenerative etiology (e.g., related to smoking or hypertension) measuring less than 5.0 to 5.5 cm in an older patient with comorbidities poses a lower risk of a catastrophic event such as dissection or rupture than the risk of surgery.4

Thresholds for surgery. To avoid high-risk emergency surgery on an acutely dissected aorta, surgery on an ascending aortic aneurysm of degenerative etiology is usually suggested when the aneurysm reaches 5.0 to 5.5 cm or a documented growth rate greater than 0.5 cm/year.1,5

(Video) Medical Treatment of Thoracic Aortic Aneurysms

Additionally, in patients already undergoing surgery for valvular or coronary disease, prophylactic aortic replacement is recommended if the ascending aorta is larger than 4.5 cm. The threshold for intervention is lower in patients with connective tissue disease (> 4.5-5.0 cm for Marfan syndrome, 4.4-4.6 cm for Loeys-Dietz syndrome, depending on family history and patient height).1,5

Observational studies suggest that the risk of aortic complications in patients with bicuspid aortic valve aortopathy is low overall, though significantly greater than in the general population.6-8 These findings led to changes in the 2014 American College of Cardiology/American Heart Association guidelines on valvular heart disease,9 suggesting a surgical threshold of 5.5 cm in the absence of significant valve disease or family history of dissection of an aorta of smaller diameter, although this was later revised, as explained below.

A 2015 study of dissection risk in patients with bicuspid aortic valve aortopathy by our group found a dramatic increase in risk of aortic dissection for ascending aortic diameters greater than 5.3 cm, and a gradual increase in risk for aortic root diameters greater than 5.0 cm.10 In addition, a near-constant 3 to 4 percent risk of dissection was present for aortic diameters ranging from 4.7 to 5.0 cm, revealing that watchful waiting carries its own inherent risks.10 In our surgical experience with this population, the hospital mortality rate and risk of stroke from aortic surgery were 0.25 and 0.75 percent, respectively.10 Thus, the decision to operate for aortic aneurysm in the setting of a bicuspid aortic valve should take into account patient-specific factors and institutional outcomes.

In light of these findings, a statement of clarification in the American College of Cardiology/American Heart Association guidelines was published in 2015, recommending surgery for patients with an aortic diameter of 5.0 cm or greater if the patient is at low risk and the surgery is performed by an experienced surgical team at a center with established surgical expertise in this condition.11 In addition, indexing a patient’s height to aortic size was also introduced as an alternative for deciding when to operate.

Ratio of aortic cross-sectional area to height

Although size alone has long been used to guide surgical intervention, a recent review from the International Registry of Aortic Dissection revealed that 59 percent of patients suffered aortic dissection at diameters less than 5.5 cm, and that patients with certain connective tissue diseases such as Loeys-Dietz syndrome or familial thoracic aneurysm and dissection had a documented propensity for dissection at smaller diameters.12-14

Size indices such as the aortic cross-sectional area indexed to height have been implemented in guidelines for certain patient populations (e.g., > 10 cm2/m in Marfan syndrome) and provide better risk stratification than size cutoffs alone.1,15

(Video) Review of Current Guidelines for Thoracic Aortic Aneurysm - Craig R Smith , MD

The ratio of aortic cross-sectional area to the patient’s height has also been applied to patients with bicuspid aortic valve-associated aortopathy and to those with a dilated aorta and a tricuspid aortic valve.16,17 Notably, a ratio greater than 10 cm2/m has been associated with aortic dissection in these groups, and this cutoff provides better stratification for prediction of death than traditional size metrics.

How should patients be screened and followed up?

Initial screening and follow-up. Follow-up of thoracic aortic aneurysm depends on the initial aortic size rate of growth or family history. For patients presenting for the first time with an aneurysm, it is reasonable to obtain definitive aortic imaging with CT or magnetic resonance angiography (MRA), then to repeat imaging at six months to document stability. If the aortic dimensions remain stable, annual follow-up with CT or MRA is reasonable.1

MRA may be preferable to CT over the long term to limit radiation exposure, although CT is more accurate.1 Echocardiography should be used if the aortic root or ascending aorta is well visualized, but in most patients the view of the mid to distal ascending aorta is limited. Echocardiography also offers evaluation of left ventricular size and function and allows for follow-up of aortic valve disease.

The following flow chart outlines our approach to initial screening and follow-up.

Thoracic Aortic Aneurysm: How to Counsel, When to Refer (1)

Screening of family members

At our center, we routinely recommend screening of all first-degree relatives of patients with thoracic aortic aneurysm if there is a suggestion of a family history. Aortic imaging with echocardiography plus CT or MRI should be considered to detect asymptomatic disease.1 In patients with a strong family history (i.e., multiple relatives affected with aortic aneurysm, dissection or sudden cardiac death), genetic screening and testing for known mutations are recommended for the patient as well as for the family members.

If a mutation is identified in a family, then first-degree relatives should undergo genetic screening for the mutation and aortic imaging.1 Imaging in second-degree relatives may also be considered if one or more first-degree relatives are found to have aortic dilation.1

We recommend similar screening of young first-degree family members of patients with bicuspid aortic valve aortopathy. In patients with young children, we recommend obtaining an echocardiogram of the child to look for a bicuspid aortic valve or aortic dilation. If an abnormality is detected or suspected, dedicated imaging with MRA to assess aortic dimensions is warranted.

References

  1. Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: executive summary. Anesth Analg. 2010;111:279-315. doi:10.1213/ANE.0b013e3181dd869b
  2. Elefteriades JA. Thoracic aortic aneurysm: reading the enemy’s playbook. Curr Probl Cardiol. 2008;33:203-277. doi:10.1016/j.cpcardiol.2008.01.004
  3. Idrees JJ, Roselli EE, Lowry AM, et al. Outcomes after elective proximal aortic replacement: a matched comparison of isolated versus multicomponent operations. Ann Thorac Surg. 2016;101:2185-2192. doi:10.1016/j.athoracsur.2015.12.026
  4. Elefteriades JA. Natural history of thoracic aortic aneurysms: indications for surgery, and surgical versus nonsurgical risks. Ann Thorac Surg. 2002;74:S1877-S1880. pmid:12440685
  5. Hiratzka LF, Creager MA, Isselbacher EM, et al. Surgery for aortic dilatation in patients with bicuspid aortic valves: a statement of clarification from the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Thorac Cardiovasc Surg. 2016;151:959-966. doi:10.1016/j.jtcvs.2015.12.001
  6. Michelena HI, Khanna AD, Mahoney D, et al. Incidence of aortic complications in patients with bicuspid aortic valves. JAMA. 2011;306:1104-1112. doi:10.1001/jama.2011.1286
  7. Tzemos N, Therrien J, Yip J, et al. Outcomes in adults with bicuspid aortic valves. JAMA. 2008;300:1317-1325. doi:10.1001/jama.300.11.1317
  8. Davies RR, Goldstein LJ, Coady MA, et al. Yearly rupture or dissection rates for thoracic aortic aneurysms: simple prediction based on size. Ann Thorac Surg. 2002;73:17-28. pmid:11834007
  9. Nishimura RA, Otto CM, Bono RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129:2440-2492. doi:10.1161/CIR.0000000000000029
  10. Wojnarski CM, Svensson LG, Roselli EE, et al. Aortic dissection in patients with bicuspid aortic valve–associated aneurysms. Ann Thorac Surg. 2015;100:1666-1674. doi:10.1016/j.athoracsur.2015.04.126
  11. Hiratzka LF, Creager MA, Isselbacher EM, et al. Surgery for aortic dilatation in patients with bicuspid aortic valves: a statement of clarification from the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2016;133:680-686. doi:10.1161/CIR.0000000000000331
  12. Pape LA, Tsai TT, Isselbacher EM, et al; International Registry of Acute Aortic Dissection (IRAD) Investigators. Aortic diameter > or = 5.5 cm is not a good predictor of type A aortic dissection: observations from the International Registry of Acute Aortic Dissection (IRAD). Circulation. 2007;116:1120-1127. doi:10.1161/CIRCULATIONAHA.107.702720
  13. Loeys BL, Schwarze U, Holm T, et al. Aneurysm syndromes caused by mutations in the TGF-beta receptor. N Engl J Med. 2006;355:788-798. doi:10.1056/NEJMoa055695
  14. Guo DC, Pannu H, Tran-Fadulu V, et al. Mutations in smooth muscle alpha-actin (ACTA2) lead to thoracic aortic aneurysms and dissections. Nat Genet. 2007;39:1488-1493. doi:10.1038/ng.2007.6
  15. Svensson LG, Khitin L. Aortic cross-sectional area/height ratio timing of aortic surgery in asymptomatic patients with Marfan syndrome. J Thorac Cardiovasc Surg. 2002;123:360-361. pmid:11828302
  16. Svensson LG, Kim KH, Lytle BW, Cosgrove DM. Relationship of aortic cross-sectional area to height ratio and the risk of aortic dissection in patients with bicuspid aortic valves. J Thorac Cardiovasc Surg. 2003;126:892-893. pmid:14502185
  17. Masri A, Kalahasti V, Svensson LG, et al. Aortic cross-sectional area/height ratio and outcomes in patients with a trileaflet aortic valve and a dilated aorta. Circulation. 2016;134:1724-1737. doi:10.1161/CIRCULATIONAHA.116.022995

Dr. Cikach is a resident physician in Cleveland Clinic’s Department of Thoracic and Cardiovascular Surgery. Dr. Desai is Professor of Medicine in the Cleveland Clinic Lerner College of Medicine and Medical Director of Cleveland Clinic’s Aorta Center. Dr. Roselli is Surgical Director of the Aorta Center. Dr. Kalahasti is Medical Director of the Marfan and Connective Tissue Disorder Clinic in the Aorta Center. Dr. Svensson is a cardiothoracic surgeon and Chairman of Cleveland Clinic’s Miller Family Heart & Vascular Institute.

(Video) Episode 5 | Latest Advances in Endovascular Repair of Ascending Thoracic Aortic Aneurysm (ATAA)

FAQs

When do you refer to a thoracic aortic aneurysm? ›

As soon as TAA is diagnosed, the patient should be referred to a cardiologist who has special interest in aortic disease. This will allow for appropriate and timely decisions about medical management, imaging, follow-up, and referral to surgery.

When should you intervene for aortic aneurysm? ›

Size threshold for surgical intervention

In addition, any aneurysms that have a growth rate greater than 0.5 cm/year are considered for surgical repair. In contrast, the size limit is reduced to 4.5–5.0 cm for syndromic aortopathy [4, 43, 47].

Is thoracic aortic aneurysm an emergency? ›

Most people with aortic aneurysms don't have symptoms unless a tear (dissection) or rupture occurs. An aortic dissection or aneurysm rupture is a medical emergency. Call 911 or your local emergency number for immediate help.

What is the most common manifestation for clients who have a thoracic aortic aneurysm? ›

Their most common presenting symptom is pain. Pain may be acute, implying impending rupture or dissection, or chronic, from compression or distention.

When is a thoracic aortic aneurysm treated? ›

Surgery is generally recommended for thoracic aortic aneurysms about 1.9 to 2.4 inches (about 5 to 6 centimeters) and larger. Surgery may be recommended for smaller aneurysms if you have a family history of aortic dissection or a condition linked to aortic aneurysm, such as Marfan syndrome.

How do you monitor thoracic aortic aneurysm? ›

How is a thoracic aortic aneurysm diagnosed?
  1. Computed tomography scan (also called a CT or CAT scan). ...
  2. Magnetic resonance imaging (MRI). ...
  3. Echocardiogram (also called echo). ...
  4. Transesophageal echocardiogram (TEE). ...
  5. Chest X-ray. ...
  6. Arteriogram (angiogram).

How do you manage an aortic aneurysm? ›

Healthy lifestyle changes
  1. Quit smoking. This is the most important part of your treatment to slow the growth of the aneurysm. ...
  2. Heart-healthy eating helps lower high blood pressure or high blood cholesterol.
  3. Manage stress to help control high blood pressure, especially for thoracic aortic aneurysms. ...
  4. Get physical activity.
24 Mar 2022

Is a 4 cm aorta normal? ›

A normal aorta is about 3 centimeters—or a little over 1 inch across. An aneurysm occurs when a portion of the aorta has enlarged to at least 1.5 times its normal size.

What is considered a large thoracic aortic aneurysm? ›

For the thoracic aorta, a diameter greater than 3.5 cm is generally considered dilated, whereas greater than 4.5 cm would be considered aneurysmal. Aneurysms may affect one or more segments of the thoracic aorta, including the ascending aorta, the arch, and the descending thoracic aorta.

What are the signs of a ruptured aortic aneurysm? ›

If an AAA bursts, it can cause:
  • sudden, severe pain in the tummy or lower back.
  • dizziness.
  • sweaty, pale and clammy skin.
  • a fast heartbeat.
  • shortness of breath.
  • fainting or passing out.

What should you not do with an aortic aneurysm? ›

DON'T:
  • Push, pull, bear down or lift anything heavier than 30 pounds (or 10 pounds for patients recovering from surgery).
  • Get a tattoo or body piercing.
  • Smoke (or be exposed to secondhand smoke) or use any other tobacco products.
  • Shovel snow, chop wood, dig earth or use a sledgehammer or snow blower.
  • Take illicit drugs.
6 Mar 2019

What happens when a thoracic aneurysm ruptures? ›

When a thoracic aneurysm ruptures, the patient will often experience excruciating chest or back pain and may have difficulty breathing and may lose consciousness. Sometimes patients will notice an unusual back pain that they have never felt before, prior to the aneurysm actually leaking.

What is the most serious complication of an aortic aneurysm? ›

A serious complication of an AAA is an aortic dissection. This is a tear in the aortic lining. It can occur anywhere along the aorta. Aortic dissection can be a life-threatening emergency.

What is the most common cause of thoracic aortic aneurysm? ›

Causes. The most common cause of a thoracic aortic aneurysm is hardening of the arteries. This condition is more common in people with high cholesterol, long-term high blood pressure, or who smoke.

How long can you have an aortic aneurysm before it ruptures? ›

It is estimated that an abdominal aortic aneurysm that is over 5.5 cm in diameter will rupture within one year in about 3 to 6 out of 100 men.

Is a 4.1 cm aorta normal? ›

The size of the aorta decreases with distance from the aortic valve in a tapering fashion. The normal diameter of the ascending aorta has been defined as <2.1 cm/m2 and of the descending aorta as <1.6 cm/m2. The normal diameter of the abdominal aorta is regarded to be less than 3.0 cm.

How often should AAA be monitored? ›

The committee discussed the cost-effectiveness results, and noted that currently monitoring small-sized aneurysms once every 2 years, and medium-sized aneurysms once every 3 months, appears to be the most effective use of resources.

Do beta blockers help with aortic aneurysm? ›

The 38 patients receiving β-blockers had a reduced aortic aneurysm growth rate of 0.36 cm per year compared with 0.68 cm per year for the 83 patients in the control group. Both of these studies concluded that β-blocker treatment significantly reduced abdominal aortic aneurysm growth rates.

At what size does an thoracic aortic aneurysm rupture? ›

The 2017 European Society for Vascular and Endovascular Surgery (ESVS) guidelines on descending thoracic aortic disease suggested that endovascular repair should be considered for descending TAAs > 60 mm diameter, as this is the diameter where risk of rupture sharply escalates (classification IIa, level B evidence).

Do aortic aneurysms have symptoms? ›

In most cases, an unruptured abdominal aortic aneurysm (AAA) will cause no symptoms, unless it becomes particularly large. Symptoms of an unruptured AAA may include: a pulsating feeling in your stomach (abdomen), usually near your belly button, that's usually only noticeable when you touch it. persistent back pain.

Can coughing cause an aortic aneurysm to rupture? ›

Because the person's coughs will increase the abdominal pressure and expose the risk of rupture of the artery.

How do paramedics treat AAA? ›

All patients with a suspected aortic aneurysm should receive 100% oxygen along with continuous electrocardiographic (ECG) and vital sign monitoring while en route to the hospital. Large-bore (14- or 16-gauge) intravenous (IV) lines should be inserted en route if possible.

How do you prevent an aneurysm from rupturing? ›

The best way to prevent getting an aneurysm, or reduce the risk of an aneurysm growing bigger and possibly rupturing, is to avoid activities that could damage your blood vessels. Things to avoid include: smoking. eating a high-fat diet.

Is a 4.4 cm aortic aneurysm? ›

The average aorta is approximately 2 cm, or slightly smaller than 1 inch. An aneurysm means that the diameter is 1.5 times larger than normal, or 3 cm, in the abdominal aorta. When an aneurysm grows to 5.5 cm in men and 5 cm in women, these tend to be the sizes where surgery is actively considered.

What size aorta require surgery? ›

They often use CT scans to monitor the aneurysm size. Your provider may recommend surgery if the aneurysm is larger than 5.5 centimeters or has grown more than 0.5 centimeters in six months.

What is the normal size of a thoracic aorta? ›

The mean total AAOD was 33.5mm and 36.0 mm in females and males respectively. The upper normal limits (mean + 2 standard deviations) of Intra-luminal AAOD, mean+ standard deviation, was 38.0, 40.7 and 42.4 mm for females and 40.2, 42.9 and 45.0 mm for males in age group 20 to 40, 41 to 60, above 60 year respectively.

How serious is a 4 mm aneurysm? ›

Aneurysm Size

Less than 3 mm in size have a low risk of rupture. Larger than 3 mm have a higher risk of bursting.

What size ascending thoracic aortic aneurysm requires surgery? ›

Surgical Treatment

For most ascending thoracic aortic aneurysms, surgery is indicated at a diameter of ≥5.5 cm. Among those with an increased operative risk (eg, the elderly or those with comorbidities), we will typically raise the threshold to 6 cm or more before recommending surgery.

How fast can a thoracic aortic aneurysm grow? ›

We found that, although a virulent disease, thoracic aortic aneurysm is an indolent process. The thoracic aorta grows very slowly — at about 0.1 cm per year.

What is considered a large thoracic aortic aneurysm? ›

For the thoracic aorta, a diameter greater than 3.5 cm is generally considered dilated, whereas greater than 4.5 cm would be considered aneurysmal. Aneurysms may affect one or more segments of the thoracic aorta, including the ascending aorta, the arch, and the descending thoracic aorta.

Is a 4 cm aorta normal? ›

A normal aorta is about 3 centimeters—or a little over 1 inch across. An aneurysm occurs when a portion of the aorta has enlarged to at least 1.5 times its normal size.

What is the most common cause of thoracic aortic aneurysm? ›

Causes. The most common cause of a thoracic aortic aneurysm is hardening of the arteries. This condition is more common in people with high cholesterol, long-term high blood pressure, or who smoke.

Are there warning signs before an aortic aneurysm? ›

The most common symptom is general belly pain or discomfort, which may come and go or be constant. Other symptoms may include: Pain in the chest, belly (abdomen), lower back, or flank (over the kidneys). It may spread to the groin, buttocks, or legs.

At what size does an thoracic aortic aneurysm rupture? ›

The 2017 European Society for Vascular and Endovascular Surgery (ESVS) guidelines on descending thoracic aortic disease suggested that endovascular repair should be considered for descending TAAs > 60 mm diameter, as this is the diameter where risk of rupture sharply escalates (classification IIa, level B evidence).

What is the prognosis for thoracic aortic aneurysm? ›

Median diameter at aneurysm rupture is 6 cm for ascending aneurysms and 7 cm for descending aneurysms; smaller aneurysms also may rupture, especially in patients with connective tissue disorders or saccular aneurysms. Survival rate of patients with untreated large TAAs is 65% at 1 year and 20% at 5 years.

At what size does an aortic aneurysm burst? ›

AAA rupture risk is typically determined by size, and it has been shown that in the 5 years following AAA diagnosis, rupture occurs in approximately 2% of AAAs less than 4 cm in diameter and in more than 25% of AAAs larger than 5 cm.

Is a 4.4 cm aortic aneurysm? ›

The average aorta is approximately 2 cm, or slightly smaller than 1 inch. An aneurysm means that the diameter is 1.5 times larger than normal, or 3 cm, in the abdominal aorta. When an aneurysm grows to 5.5 cm in men and 5 cm in women, these tend to be the sizes where surgery is actively considered.

What size aorta require surgery? ›

They often use CT scans to monitor the aneurysm size. Your provider may recommend surgery if the aneurysm is larger than 5.5 centimeters or has grown more than 0.5 centimeters in six months.

What is the normal size of a thoracic aorta? ›

The mean total AAOD was 33.5mm and 36.0 mm in females and males respectively. The upper normal limits (mean + 2 standard deviations) of Intra-luminal AAOD, mean+ standard deviation, was 38.0, 40.7 and 42.4 mm for females and 40.2, 42.9 and 45.0 mm for males in age group 20 to 40, 41 to 60, above 60 year respectively.

What can you not do with a thoracic aortic aneurysm? ›

DON'T:
  • Push, pull, bear down or lift anything heavier than 30 pounds (or 10 pounds for patients recovering from surgery).
  • Get a tattoo or body piercing.
  • Smoke (or be exposed to secondhand smoke) or use any other tobacco products.
  • Shovel snow, chop wood, dig earth or use a sledgehammer or snow blower.
  • Take illicit drugs.
6 Mar 2019

What are the signs of a ruptured aortic aneurysm? ›

If an AAA bursts, it can cause:
  • sudden, severe pain in the tummy or lower back.
  • dizziness.
  • sweaty, pale and clammy skin.
  • a fast heartbeat.
  • shortness of breath.
  • fainting or passing out.

What happens when a thoracic aneurysm ruptures? ›

When a thoracic aneurysm ruptures, the patient will often experience excruciating chest or back pain and may have difficulty breathing and may lose consciousness. Sometimes patients will notice an unusual back pain that they have never felt before, prior to the aneurysm actually leaking.

How long can you have an aortic aneurysm before it ruptures? ›

It is estimated that an abdominal aortic aneurysm that is over 5.5 cm in diameter will rupture within one year in about 3 to 6 out of 100 men.

How can you prevent an aneurysm from rupturing? ›

maintaining a healthy weight – even losing just a few pounds will make a big difference to your blood pressure and overall health. exercising regularly – being active and taking regular exercise lowers blood pressure by keeping your heart and blood vessels in good condition.

What are the 3 types of aneurysms? ›

The three types of cerebral aneurysms are: berry (saccular), fusiform and mycotic. The most common, "berry aneurysm," occurs more often in adults. It can range in size from a few millimeters to more than two centimeters. A family history of aneurysms may increase your risk.

Videos

1. Management of Aortic Aneurysms
(Beth Israel Deaconess Medical Center (BIDMC))
2. Familial Thoracic Aortic Aneurysms and Dissections | Webinar | Ambry Genetics
(Ambry Genetics)
3. What is familial aortic aneurysm?
(The Marfan Foundation)
4. Understanding Abdominal Aortic Aneurysms
(Zero To Finals)
5. Endovascular Repair for Aortic Aneurysms
(UW Health)
6. Abdominal aortic aneurysms | Circulatory System and Disease | NCLEX-RN | Khan Academy
(khanacademymedicine)

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