Vessel

Thoracic Aortic Aneurysm

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Thoracic Aortic Aneurysm

  • Definitions
  1. Thoracic Aortic Aneurysm
    1. Widened diameter of the thoracic aorta at least 1.5 times greater than normal thoracic aorta
  • Epidemiology
  1. Incidence: 6-10 per 100,000 persons (approximately 15,000 persons in U.S. per year)
  • Risk Factors
  1. Marfan Syndrome
  2. Loeys-Dietz Syndrome
  3. Family History of Aortic Dissection
  • Types
  1. Location
    1. Aortic Root or ascending aorta (60%)
    2. Aortic Arch (10%)
    3. Descending Aorta (40%)
    4. Thoracoabdominal Aorta (10%)
  2. Shape
    1. Fusiform (uniform shape)
    2. Saccular (bulbous on one side)
  • Complications
  1. Thoracic Dissection
    1. See Thoracic Dissection for risk factors
  1. Tobacco Cessation
  2. Hyperlipidemia Management
  3. Hypertension Management (goal <130/80)
    1. Beta Blocker AND
    2. ACE Inhibitor or Angiotensin Receptor Blocker
  • Management
  • Surgery Indications
  1. Asymptomatic patients without underlying conditions
    1. Diameter >5.5 cm in asymptomatic patient AND one of the following
      1. Degenerative aortic aneurysm
      2. Chronic Aortic Dissection
      3. Intramural Hematoma
      4. Penetrating atherosclerotic ulcer
      5. Mycotic aneurysm
      6. Pseudoaneurysm
    2. Diameter <5.5 cm in asymptomatic patient AND
      1. Increase in ascending aortic diameter >0.5 cm/year
  2. Ascending Thoracic aorta or aortic sinus diameter in Collagen vascular disorder
    1. Diameter >4.2 cm by echo (>4.4 to 4.6 cm by CT or MRI) in asymptomatic Loeys-Dietz Syndrome
    2. Diameter >4 cm in asymptomatic Marfan Syndrome patient desiring pregnancy
    3. Diameter >4 to 5 cm in asymptomatic Marfan Syndrome patient
      1. Especially if Family History of Aortic Dissection, increase in ascending aortic diameter >0.5 cm/year
  3. Asymptomatic patients with bicuspid aortic valve
    1. Diameter >5.5 cm in asymptomatic patient with bicuspid aortic valve
    2. Diameter >5.0 cm in asymptomatic patient with bicuspid aortic valve AND
      1. Family History of Aortic Dissection
      2. Increase in ascending aortic diameter >0.5 cm/year
    3. Diameter >4.5 cm in bicuspid aortic valve undergoing aortic Valve Replacement
  • References
  1. Aronow (2018) Ann Transl Med 6(3): 66-8 [PubMed]
  2. Isselbacher (2005) Circulation 111:816-28 [PubMed]