THORACIC AND
THORACO-ABDOMINAL
AORTIC ANEURYSMS

The most common site of arterial swelling (aneurysm) in the body is in the abdomen (tummy). However, more rarely, swelling can also affect the main artery in the chest, sometimes along with the artery in the abdomen. This is called a thoracic or thoraco-abdominal aneurysm (TAA or TAAA for short). Similar to the more common abdominal aortic aneurysm, TAA and TAAA can get progressively larger, and if big enough, burst. This is a very serious event which people are unlikely to survive. It is preferable, therefore, to repair such aneurysms before the risk of bursting becomes high.

THORACIC AORTIC ANEURYSM (TAA)

THORACIC AORTIC ANEURYSM (TAA)

Treatment

Medication.

At present, there is no medication known to stabilise or reduce the size of TAAA. There is evidence that stopping smoking and treatment of high blood pressure can slow the growth of aortic aneurysms.

Assessment.

Before treatment, patients are assessed extremely thoroughly, with a series of tests examining their heart, lungs and how their body will withstand a large operation. This helps decision-making for the best means of treating patients and ensures patients are in the best shape to undergo surgery.

Surgery.

There are two methods of treating aneurysms involving the thoracic aorta:
  • Endovascular stent graft. This is a similar method to EVAR used in abdominal aortic aneurysms. Under an anaesthetic, a small cut is made in one groin to access the groin artery. Through this artery, a stent graft is delivered up to the aorta in the chest, where it is deployed, relining the aorta and sealing off the aneurysm. This normally allows patients to recover quickly, and leave hospital within a few days. However, as the stent graft completely seals the aorta, it will also block off any branches which come off the aorta where it is deployed. It cannot therefore be used where there are important arterial branches, such as the blood supply to the brain, stomach, bowel and kidneys. In practice, this means its use is restricted to aneurysms confined to the chest, and not extending up towards the heart, and down into the abdomen. More complex stent grafts are in development, which may eventually allow the treatment of more extensive aneurysms.
  • Open surgery. Extensive TAAA require open surgery when they become large. This requires a large cut in the abdomen, and sometimes the chest. It involves temporarily shutting off the blood supply to the stomach, liver, kidneys and sometimes the spinal cord. The duration of time these organs are without blood is minimised by the use of a bypass circuit when possible, and special techniques are use to minimise the injury to the spinal cord.
THORACIC AORTIC ANEURYSM (TAA)
THORACIC AORTIC ANEURYSM (TAA)
THORACIC STENT GRAFT
THORACO-ABDOMINAL AORTIC ANEURYSM (TAAA)