Podcast
Questions and Answers
What is the most common pathology associated with ascending aortic aneurysms?
What is the most common pathology associated with ascending aortic aneurysms?
What is the average growth rate of thoracic aortic aneurysms?
What is the average growth rate of thoracic aortic aneurysms?
What is the risk of rupture of a thoracic aortic aneurysm 6 cm in diameter?
What is the risk of rupture of a thoracic aortic aneurysm 6 cm in diameter?
What is the first test that may suggest the diagnosis of a thoracic aortic aneurysm?
What is the first test that may suggest the diagnosis of a thoracic aortic aneurysm?
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How often should noninvasive testing with contrast-enhanced CT or MRI be performed to monitor expansion in asymptomatic patients with small aneurysms?
How often should noninvasive testing with contrast-enhanced CT or MRI be performed to monitor expansion in asymptomatic patients with small aneurysms?
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What is the primary indication for operative repair in patients with asymptomatic ascending thoracic aortic aneurysms?
What is the primary indication for operative repair in patients with asymptomatic ascending thoracic aortic aneurysms?
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What is the benefit of angiotensin receptor antagonists in patients with Marfan’s syndrome?
What is the benefit of angiotensin receptor antagonists in patients with Marfan’s syndrome?
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What is the most common cause of abdominal aortic aneurysms >4.0 cm?
What is the most common cause of abdominal aortic aneurysms >4.0 cm?
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What is the recommendation for patients with bicuspid aortic valves undergoing aortic valve replacement?
What is the recommendation for patients with bicuspid aortic valves undergoing aortic valve replacement?
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What is the indication for endovascular repair in patients with degenerative descending thoracic aortic aneurysms?
What is the indication for endovascular repair in patients with degenerative descending thoracic aortic aneurysms?
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Study Notes
Thoracic Aortic Aneurysms
- Location of thoracic aortic aneurysm determines clinical manifestations and natural history
- Medial degeneration is the most common pathology associated with ascending aortic aneurysms
- Atherosclerosis is the condition most frequently associated with aneurysms of the descending thoracic aorta
- Average growth rate of thoracic aneurysms is 0.1–0.2 cm per year
- Thoracic aortic aneurysms associated with Marfan’s syndrome or aortic dissection may expand at a greater rate
- Risk of rupture is related to size of aneurysm and presence of symptoms, ranging from 2–3% per year for aneurysms 6 cm in diameter
- Most thoracic aortic aneurysms are asymptomatic
- Compression or erosion of adjacent tissue by aneurysms may cause symptoms such as chest pain, shortness of breath, cough, hoarseness, and dysphagia
Diagnosis and Management
- Chest x-ray may be the first test that suggests the diagnosis of thoracic aortic aneurysm
- Findings on chest x-ray include widening of mediastinal shadow and displacement or compression of trachea or left main stem bronchus
- Echocardiography, particularly transesophageal echocardiography, can be used to assess proximal ascending aorta and descending thoracic aorta
- Contrast-enhanced CT, magnetic resonance imaging (MRI), and conventional invasive aortography are sensitive and specific tests for assessment of aneurysms of thoracic aorta and involvement of branch vessels
- Noninvasive testing with either contrast-enhanced CT or MRI should be performed at least every 6–12 months to monitor expansion in asymptomatic patients
- β-Adrenergic blockers are recommended for patients with thoracic aortic aneurysms, particularly those with Marfan’s syndrome
- Additional medical therapy should be given as necessary to control hypertension
- Angiotensin receptor antagonists may reduce rate of aortic dilation in patients with Marfan’s syndrome by blocking TGF-β signaling
Surgical Indications
- Operative repair is indicated in patients with symptomatic ascending thoracic aortic aneurysms
- Operative repair is also indicated for most asymptomatic aneurysms, including those associated with bicuspid aortic valves when aortic root or ascending aortic diameter is ≥5.5 cm, or when growth rate is >0.5 cm per year
- Replacement of ascending aorta >4.5 cm is reasonable in patients with bicuspid aortic valves undergoing aortic valve replacement due to severe aortic stenosis or aortic regurgitation
- In patients with Marfan’s syndrome, ascending thoracic aortic aneurysms of 4–5 cm should be considered for surgery
Abdominal Aortic Aneurysms
- Abdominal aortic aneurysms occur more frequently in males than in females and incidence increases with age
- Cigarette smoking is a potent modifiable risk factor
- Abdominal aortic aneurysms ≥4.0 cm may affect 1–2% men aged >50 years
- At least 90% of all abdominal aortic aneurysms >4.0 cm are related to atherosclerotic disease
- Prognosis is related to both size of aneurysm and the symptoms
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Description
Learn about the clinical manifestations, natural history, and growth rate of thoracic aortic aneurysms, including their association with Marfan's syndrome and aortic dissection.
