Thoracic aortic aneurysm

Diagnosis

Thoracic aortic aneurysms are often found when an imaging test is done for a different reason.

If you have symptoms of a thoracic aortic aneurysm, your health care provider may ask about your family's medical history. Some aneurysms can run in families.

Tests

Imaging tests can be used to confirm or screen for a thoracic aortic aneurysm. Tests may include:

• Echocardiogram. This test uses sound waves to show how blood moves through the heart and blood vessels, including the aorta. An echocardiogram may be used to diagnose or screen for thoracic aortic aneurysms. If a standard echocardiogram doesn't provide enough information about the aorta, a transesophageal echocardiogram may be done to get a better view. For this type of echocardiogram, a flexible tube containing an ultrasound wand is guided down the throat and into the tube connecting the mouth to the stomach.
• Computerized tomography (CT). CT uses X-rays to create cross-sectional images of the body, including the aorta. It can show the size and shape of an aneurysm. During a CT scan, you typically lie on a table inside a doughnut-shaped X-ray machine. Dye, called contrast, may be given by IV to help the arteries show up more clearly on the X-ray.
• Cardiac magnetic resonance imaging (MRI). A cardiac MRI uses magnetic fields and radio waves to create detailed images of the heart and aorta. It can help diagnose an aneurysm and show its size and location. In this test, you typically lie on a table that slides into a tunnel. Dye may be given by IV to help blood vessels show up more clearly on the images. This test doesn't use radiation. It may be an option to CT scans for people who need frequent aneurysm imaging tests.

Treatment

The goal of treatment for a thoracic aortic aneurysm is to prevent the aneurysm from growing and rupturing. Treatment depends on the aneurysm's size and how fast it's growing.

Treatment for thoracic aortic aneurysm may include:

• Regular health checkups, sometimes called watchful waiting.
• Medicines.
• Surgery.

If your thoracic aortic aneurysm is small, your health care provider may recommend medicine and imaging tests to watch the aneurysm. Other health conditions will be treated and managed.

Usually, you'll have an echocardiogram, CT or magnetic resonance angiography (MRA) scan at least six months after your aneurysm is diagnosed. An imaging test also may be done at regular follow-up exams. How often you have these tests done depends on the cause and size of the aneurysm, and how fast it's growing.

Medications

Medicines may be prescribed to treat high blood pressure and high cholesterol.

These medicines could include:

• Beta blockers. These medicines lower blood pressure by slowing the heart rate. They may reduce how fast the aorta is widening in people with Marfan syndrome.
• Angiotensin 2 receptor blockers. These medicines may be used if beta blockers can't be taken or if they don't adequately control blood pressure. They are often recommended for people who have Loeys-Dietz syndrome even if they don't have high blood pressure. Examples of angiotensin 2 receptor blockers include losartan (Cozaar), valsartan (Diovan) and olmesartan (Benicar).
• Statins. These medicines can help lower cholesterol, which can help reduce blockages in the arteries and reduce the risk of aneurysm complications. Examples of statins include atorvastatin (Lipitor), lovastatin (Altoprev), simvastatin (Zocor, FloLipid) and others.

If you smoke or chew tobacco, it's important that you quit. Using tobacco can worsen an aneurysm and overall health.

Surgery

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.

Most people with a thoracic aortic aneurysm have open-chest surgery, but sometimes a less invasive procedure called endovascular surgery can be done.

The type of surgery done depends on the specific health condition and the location of the thoracic aortic aneurysm.

• Open-chest surgery. This surgery generally involves removing part of the aorta damaged by the aneurysm. The section of aorta is replaced with a synthetic tube, called a graft, which is sewn into place. Full recovery may take a month or more.
• Aortic root surgery. This type of open-chest surgery is done to treat an enlarged section of the aorta to prevent a rupture. Aortic aneurysms near the aortic root may be related to Marfan syndrome and other related conditions. A surgeon removes part of the aorta and sometimes the aortic valve. A graft replaces the removed section of the aorta. The aortic valve may be replaced with a mechanical or biological valve. If the valve is not removed, the surgery is called valve-sparing aortic root repair.

• Endovascular aortic aneurysm repair (EVAR). The surgeon inserts a thin, flexible tube into a blood vessel, usually in the groin, and guides it to the aorta. A metal mesh tube, called a graft, on the end of the catheter is placed at the aneurysm site. Small hooks or pins hold it in place. The graft reinforces the weakened section of the aorta to prevent rupture of the aneurysm. This catheter-based procedure may allow a faster recovery.

  EVAR can't be done on everyone. Ask your health care provider whether it's right for you. After EVAR, you'll need regular imaging tests to check the graft for leakage.

• Emergency surgery. A ruptured thoracic aortic aneurysm requires emergency open-chest surgery. This type of surgery is risky and has a high chance of complications. That's why it's important to identify and treat thoracic aortic aneurysms before they rupture with lifelong health checkups and appropriate preventive surgery.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Lifestyle and home remedies

If you have a thoracic aortic aneurysm, your health care provider may tell you not to do heavy lifting and some vigorous physical activities. Such activities can increase blood pressure, putting additional pressure on your aneurysm.

If you want to participate in a particular activity, your health care provider may recommend an exercise stress test to see how exercise affects your blood pressure. Moderate physical activity is generally healthy for you.

Stress also can raise blood pressure, so find ways to help reduce emotional stress. Getting more exercise and practicing mindfulness are some ways to reduce stress.

Coping and support

Some people with a thoracic aortic aneurysm or related conditions may feel anxious, worried or depressed. You may find that connecting with others who have experienced similar situations may be helpful. Talk to your health care provider about support groups in your area.

Preparing for your appointment

If you think you may have a thoracic aortic aneurysm or are worried about your aneurysm risk because of a strong family history, make an appointment with your care provider. If an aneurysm is found early, treatment may be easier and more effective.

If you're being screened for an aortic aneurysm, your health care provider will likely ask if anyone in your family has ever had an aortic aneurysm, so have that information ready.

Because appointments can be brief and there's often a lot to discuss, it's a good idea to be prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your health care provider.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance. For an echocardiogram, for example, you may need to avoid food or drinks for a period beforehand.
• Write down any symptoms you're having, including any that may seem unrelated to a thoracic aortic aneurysm.
• Write down important personal information, including a family history of heart disease, aneurysms or connective tissue disease.
• Make a list of all medicines, vitamins or supplements that you take. Include dosages.
• Take a family member or friend along, if possible. Sometimes it can be difficult to remember the information provided to you during an appointment. Someone who goes with you may remember something that you missed or forgot.
• Be prepared to discuss your diet, exercise habits and tobacco use. If you don't already follow a diet or exercise routine, tell your care provider about any challenges you might face in getting started. Be sure to tell your health care provider if you're a current or former smoker.
• Send imaging reports and bring records. It's helpful if you can send imaging reports to your health care provider in advance and bring your medical records.
• Write down questions to ask your health care provider.

Your time with your health care provider is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For an aortic aneurysm, some basic questions to ask your health care provider include:

• What kinds of tests will I need to confirm a thoracic aortic aneurysm?
• What size is my aneurysm?
• What treatments are available, and which do you recommend for me?
• What's an appropriate level of physical activity?
• Do I need to change my diet?
• How often should I be screened for an aneurysm?
• Should I tell other family members to be screened for an aneurysm?
• I have other health conditions. How can I best manage these conditions together?
• Is there a generic alternative to the medicine you're prescribing me?
• Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting for more information?

In addition to the questions that you've prepared to ask your health care provider, don't hesitate to ask additional questions during your appointment.

What to expect from your doctor

Your health care provider is likely to ask you several questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your health care provider may ask:

• When did you first begin having symptoms?
• Do your symptoms come and go, or do you have them all the time?
• How severe are your symptoms?
• Do you have a family history of aneurysms or genetic diseases, such as Marfan syndrome?
• Have you ever smoked?
• Have you ever been told you have high blood pressure?
• Does anything improve your symptoms?
• What, if anything, appears to worsen your symptoms?

What you can do in the meantime

It's never too early to make healthy lifestyle changes, such as quitting smoking, eating healthy foods and getting more exercise. Taking these steps can help prevent thoracic aortic aneurysm and its complications.

If you're diagnosed with a thoracic aortic aneurysm, ask how often you should visit your health care provider for follow-up appointments.

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