A thoracic aortic aneurysm is defined as a localized enlargement that has a diameter that exceeds 1.5 times the normal expected diameter of the aorta at that location. Aneurysms of the thoracic aorta affect approximately 15-20,000 Americans each year, resulting in nearly 6,000 deaths.
Risk Factors for Aortic Aneurismal Disease
- Family history of aneurismal disease
- History of prior arterial aneurysm substantially increases risk of developing additional aneurysm
- Personal history of atherosclerotic disease including cardiovascular or peripheral vascular disease
Signs and Symptoms
The majority of patients with aneurysms of the aorta
are asymptomatic; however, common symptoms
associated with aortic aneurysm disease are:
- Chest, flank, back or abdominal pain or cramping
- Voice change, chronic cough or hoarseness (resulting from aneurysm causing traction on recurrent laryngeal nerve)
- Distal atheroemboli to legs, feet or toes
- Pulsatile mass in abdomen
Traditionally thoracic aortic aneurysms have been treated by resection of the aneurysm and replacement of the aneurismal aorta with a prosthetic graft.
The invasiveness of this procedure is often too much for patients to tolerate, especially given the other major co-morbidities such as diabetes, peripheral vascular disease, chronic obstructive pulmonary disease and coronary artery disease that often affect these patients. Hence, operative mortality rates range from
8-20% and major morbidity rates are as high as 20% with conventional open surgery.
The advent of endovascular stent grafts has revolutionized the treatment of patients with thoracic aortic aneurysms allowing operative mortality rates as low as 1%. The minimally invasive nature of the endovascular approach has also resulted in a drastic reduction in the recovery period with most patients requiring only a 3-day hospital stay (compared with an average 10-day hospital stay with conventional open surgery).