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Thoracic Aortic Aneurysm
Aka: Thoracic Aortic Aneurysm
- Definitions
- Thoracic Aortic Aneurysm
- Widened diameter of the thoracic aorta at least 1.5 times greater than normal thoracic aorta
- Epidemiology
- Incidence: 6-10 per 100,000 persons (approximately 15,000 persons in U.S. per year)
- Risk Factors
- Marfan Syndrome
- Loeys-Dietz Syndrome
- Family History of Aortic Dissection
- Types
- Location
- Aortic Root or ascending aorta (60%)
- Aortic Arch (10%)
- Descending Aorta (40%)
- Thoracoabdominal Aorta (10%)
- Shape
- Fusiform (uniform shape)
- Saccular (bulbous on one side)
- Complications
- Thoracic Dissection
- See Thoracic Dissection for risk factors
- Management: Control risk factors to prevent Aortic Dissection
- Tobacco Cessation
- Hyperlipidemia Management
- Hypertension Management (goal <130/80)
- Beta Blocker AND
- ACE Inhibitor or Angiotensin Receptor Blocker
- Management: Surgery Indications
- Asymptomatic patients without underlying conditions
- Diameter >5.5 cm in asymptomatic patient AND one of the following
- Degenerative aortic aneurysm
- Chronic Aortic Dissection
- Intramural hematoma
- Penetrating atherosclerotic ulcer
- Mycotic aneurysm
- Pseudoaneurysm
- Diameter <5.5 cm in asymptomatic patient AND
- Increase in ascending aortic diameter >0.5 cm/year
- Ascending Thoracic aorta or aortic sinus diameter in collagen vascular disorder
- Diameter >4.2 cm by echo (>4.4 to 4.6 cm by CT or MRI) in asymptomatic Loeys-Dietz Syndrome
- Diameter >4 cm in asymptomatic Marfan Syndrome patient desiring pregnancy
- Diameter >4 to 5 cm in asymptomatic Marfan Syndrome patient
- Especially if Family History of Aortic Dissection, increase in ascending aortic diameter >0.5 cm/year
- Asymptomatic patients with bicuspid aortic valve
- Diameter >5.5 cm in asymptomatic patient with bicuspid aortic valve
- Diameter >5.0 cm in asymptomatic patient with bicuspid aortic valve AND
- Family History of Aortic Dissection
- Increase in ascending aortic diameter >0.5 cm/year
- Diameter >4.5 cm in bicuspid aortic valve undergoing aortic Valve Replacement
- References
- Aronow (2018) Ann Transl Med 6(3): 66-8 [PubMed]
- Isselbacher (2005) Circulation 111:816-28 [PubMed]