Cardiothoracic Surgery

Thoracic Aortic Aneurysm Repair

Young female doctor examining an older male patient

Thoracic aortic aneurysms, or TAAs, are bulges in the aortic wall in the chest region caused by weakening of the wall of the aorta. When a section of the vascular wall weakens, the pressure of the blood as it is pumped through the aorta causes the abnormal bulging in the weakened area. These aneurysms typically are asymptomatic. If they rupture, they may cause death from internal bleeding. Among people who have thoracic aortic aneurysms that rupture, between 50 and 80 percent die. The serious risks associated with TAAs make early diagnosis and treatment of them critical. When the risk of a rupture is greater than the risk of surgery, a doctor may recommend thoracic aortic aneurysm repair.

Causes

The weakening of the aortic wall is more common in elderly people. They may be caused by hardening of the arteries, which is called atherosclerosis, certain infections, and some inherited disorders. People who smoke or have high blood pressure also have a greater risk of developing thoracic aortic aneurysms.

Locations and Shapes

People may develop aneurysms anywhere in their aortas. While a majority of aortic aneurysms occurs in the abdominal segment, they may also happen in the thoracic portion. Some people may have aneurysms located on the walls of their aortas in both the abdominal and thoracic sections.

TAAs are further divided into FOUR primary categories denoting their location:

  • Descending thoracic aortic aneurysms
  • Aortic arch aneurysms
  • Ascending thoracic aortic aneurysms

Thoracoabdominal Aortic Aneurysms

An aneurysm may affect only a small portion of one side of the aortic wall, forming a bubble-like bulge. It may also affect the entire circumference of the aorta, making it bulge in a sausage shape.

Open Thoracic Aortic Aneurysm Repair

Open-chest thoracic aortic aneurysm repair is the standard surgical treatment used for TAAs. This is a major surgery requiring hospitalization for multiple days. The patient is placed under general anesthesia. The surgeon then makes an incision that is usually located on the patient's left side. The doctor will then spread opens the person's ribs so that he or she can expose the aorta. After finding the weakened area, the surgeon replaces the weak section with an artificial vessel that is made out of a type of specialized cloth. While this is being done, the aorta must be clamped off and the blood flow to the area temporarily stopped. Doctors use pumps in order to maintain the flow of blood to other areas of the body during the surgery.

A doctor will determine when a surgery is needed by measuring the size of the weakened area using a CT scan. As the aortic wall becomes weaker, the aneurysm will increase in size. Larger bulges have a greater chance of rupturing and doctors will recommend a surgical intervention.

Endovascular Thoracic Aortic Aneurysm Repair

Some are able to have endovascular thoracic aortic aneurysm repair instead of open-chest thoracic aortic aneurysm repair. In order for a person to be eligible for this alternative, his or her anatomy must be compatible with the sleeves that are used to make the repair.

If a person is able to have endovascular repairs completed, it is the preferred method because the recovery time is quicker. In this procedure, the surgeon makes a small incision in the person's groin area and then uses tiny catheters to guide the sleeve through the aorta to the weak area. The sleeve is carefully put into place in the weak area. This helps by taking the pressure away from the weakened section.

Possible Complications

There are several potential complications to having either endovascular or open-chest thoracic aortic aneurysm repairs performed. The risks include the following:

  • Paralysis
  • Infection
  • Sleeves migrating away from the weakened site
  • Bleeding around the sleeve
  • Delayed rupturing of the aorta
  • Loss of kidney function
  • Surgical complications such as pneumonia

Recovery

Recovery from the open-chest surgical procedure takes much longer than recovery from the endovascular repair procedure. Following the open surgery, the patient will normally remain in the hospital in intensive care for a couple of days. The patient will then have a period of time during which he or she will gradually increase his or her physical activity. Recovering from the endovascular procedure will require a hospital stay of 2 to 3 days.

Following both surgeries, people will be restricted from driving for up to 2 weeks. They will not be allowed to take baths until the incisions are fully healed although showers are allowed. They will also be restricted from lifting weights of greater than 10 pounds for up to 6 weeks following the surgery. Most people who have these procedures make full recoveries and are able to go on with their lives.