Treatment of Thoracic Aortic Aneurysm

Watchful Waiting and Medical Treatment

Small aneurysms, less than 5cm, have minimal risk of rupture and the risks of operative management outweigh the anticipated benefits.

If you have a small aneurysm, your vascular surgeon will ask you to come back every 6 to 12 months for a CTA or ultrasound to measure the size of your aneurysm and to review any other symptoms you may have.

Your doctor will further monitor and control your blood pressure and your cholesterol levels with appropriate medication (antihypertensives and lipid lowering agents/statins).

You may also be asked to start a baby aspirin that controls the complications of atherosclerosis. If you smoke, you should obtain help to stop smoking.

A healthy living with regular physical exercise is also recommended. An aneurysm will not "go away" by itself; however appropriate medical treatment can slow or even cease its growth.

It is extremely important to continue to follow up with your physician as directed because the aneurysm may enlarge to a dangerous size over time.

There is no need for physical activities or work restrictions provided that these remain within reasonable limits.

Rarely a small (4-5cm) aneurysm may require operative treatment. This will be in the cases of rapid expansion, manifestation of symptoms (e.g. pain) or because of a saccular shape (versus a fusiform/conical shape) that may indicate a higher risk for rupture. Your vascular surgeon will guide you as needed.

Open Thoracic Aortic Aneurysm Repair

This has been the traditional and only type of treatment before the minimally invasive endovascular repair revolutionized the management of abdominal aortic aneurysms.

Open aneurysm repair is still though a needed and for a subset of patients the only alternative.

This involves the vascular or cardiac surgeon making large incision through the breastbone (median sternotomy) or from the back under the shoulder blade around the side of the rib cage to just under the breast (thoracotomy).

These approaches allow the surgeon to visualize the aorta directly to repair the aneurysm.

The diseased portion of the aorta is replaced with a woven cylindrical graft that acts as a replacement blood vessel.

Sometimes if the aortic valve is damaged, your surgeon may decide to replace it at the same time. Thoracic aneurysm surgery is highly effective and durable.

Typically patients who undergo this procedure have a supervised hospital stay for up to a week after surgery, and it takes one to three months for a complete recovery.

As with any operation, open surgical repair has a risk of minor and major complications. You will want to discuss them thoroughly with your vascular surgeon.

Thoracic Endovascular Aortic Aneurysm Repair

The majority of aortic aneurysm repairs are currently done with a minimally invasive technique called thoracic endovascular aneurysm repair (TEVAR); not all patients are suitable candidates though.

TEVAR is a procedure that requires only small, or no incisions in the groin. With the use of X-ray guidance and special endovascular wires and catheters guided through the vascular lumen, a stent-graft (covered metallic tube) is inserted via the femoral artery and advanced up into the aorta to the site of the aneurysm.

The stent-graft is expanded inside the aorta and held in place with metallic hooks and stents rather than sutures.

Typically patients who undergo this procedure have a supervised hospital stay for a couple of days after surgery, and it takes a few days for a complete recovery.

As with any operation, endovascular aneurysm repair has a risk of complications and requires lifelong surveillance. You will want to discuss these thoroughly with your vascular surgeon.