- Dilatation of thoracic aorta 1.5x
Incidence
Classification
- Ascending aortic aneurysms
- Arise anywhere from the aortic valve to the brachiocephalic trunk (ie, innominate artery; 60 percent)
- Aortic arch aneurysms
- Include any thoracic аոeuryѕm that involves the brachiocephalic vessels (10 percent)
- Descending aortic aneurysms
- Distal to the left subclavian artery (40 percent)
- Thoracoabdominal aneurysms (10 percent)
Aetiology
- Arteriosclerosis
- Medial degeneration of the aortic wall
- Marfans syndrome
- Trauma
- Infection
Clinical
- Usually have a history of HTN
Pathology
- Medial degeneration of the aortic wall: Replacement of muscle cells & elastic lamina with mucoid-filled cystic spaces
Investigations
- CXR: Convexity at R heart border
- CT
- MRA
- Coronary angiogram – to screen for coexistent coronary artery disease
Management
- Asymptomatic patients
- Sporadic
- If <5.5 Aggressive BP control and surveillance
- If Aneurysm > 5.5 cm & asymptomatic = consider surgery
- Marfan’s Syndrome
- Intervention recommended at 4.5-5cm depending on risk factors
- Other risk factors to consider small size of intervension
- аոeսrуѕm expansion >0.5 cm per year, saccular аոеurуѕm, infectious аոеսrуѕm, female sex
- Approach
- Ascending Aorta
- Open surgery using cardiopulmonary bypass and sometimes requires aortic root replacement with coronary artery reimplantation]
- Descending Aorta
Prognosis
- If untreated ≈ 50% of non-dissecting thoracic aneurysms will rupture
- ↑ Risk of rupture:
- Size
- Underlying CT disorder
- Dissection
- COPD
- Advancing age