South Florida Sun-Sentinel Palm Beach (Sunday)
Q&A Treating blood vessel aneurysms
Q: My friend was diagnosed with a thoracic aortic aneurysm. What causes this type of aneurysm, and how fast does it grow? Also, how are they treated?
A: A thoracic aortic aneurysm occurs when one or more areas along the wall of the aorta — the body’s largest blood vessel — becomes weak or damaged. The aorta carries oxygen-filled blood from the heart to the body, including the brain. With time, the pressure of blood flowing through the weakened area can cause it to enlarge or bulge — typically without signs or symptoms.
Most commonly, bulges occur in the abdomen, called an abdominal aortic aneurysm. Aneurysms also can develop closer to the heart, and these aneurysms can develop in the ascending aorta or descending thoracic aorta.
The main concern with aortic aneurysms in the chest is a tear, dissection or rupture that allows blood to leak into the aorta’s lining or into the body. With a dissection or rupture, it’s important to recognize these symptoms:
Sharp, severe or sudden chest or upper back pain that radiates downward, or includes the jaw, neck or arms
Difficulty breathing or swallowing
Clamminess
Immediate emergency care is necessary for a dissection or rupture. Unfortunately, dissections and ruptures often are fatal.
Most aortic aneurysms are small and develop slowly. They are discovered when imaging is performed on the chest or abdominal area for another reason. A smaller aneurysm has a low risk of rupture — about 1% or less per year. For that reason, as long as it’s not growing quickly, providers will recommend a watch-andwait approach. This means using imaging tests, such as echocardiogram or CT scans, at regular intervals to monitor the aneurysm’s size and rate of growth. Health care providers also may prescribe medications such as beta blockers.
Typically, an aneurysm grows slowly, although it can grow faster, particularly in people with a family history of aortic aneurysms or with a genetic condition related to the body’s connective tissues. If an aneurysm is larger or growing quickly, elective surgery to repair the aneurysm may be considered. This may involve open-chest surgery or an endovascular option where a stent is placed to cover the aneurysm.
The goal is to remove the damaged section of the aorta and replace it with a synthetic tube, or graft, or allow the blood to flow through the stent graft instead.
Men are more likely than women to develop a thoracic aortic aneurysm. The condition usually occurs in people in their 50s and 60s, although it may not be detected until decades later, if at all.
Other factors that increase the risk of a thoracic aortic aneurysm include high blood pressure; smoking; high cholesterol levels; and blood vessel hardening and clogging, or atherosclerosis.
People at highest risk — those with a family history plus other risk factors — should ask their primary doctor about having an echocardiogram to look for a thoracic aneurysm, even in the absence of symptoms. Surgery is recommended for thoracic aortic aneurysms with a diameter of 2.2 inches or larger. — Young Erben, M.D., Vascular Surgery, Mayo Clinic, Jacksonville, Florida
Mayo Clinic Q&A is an educational resource and doesn’t replace regular medical care. Email a question to MayoClinicQ&A@ mayo.edu.