A thoracic aortic aneurysm is a time bomb in your chest. This is a local enlargement of the aorta, which can rupture a blood vessel. Only a few people survive after the development of this complication. Timely treatment is required to prevent the aneurysm from rupturing. Doctors abroad can provide treatment with endovascular techniques: through an incision in the leg.
Content
- Causes
- Symptoms
- Diagnostics
- Who needs surgery
- What operations can be used
Causes
The most common cause of a thoracic aortic aneurysm is atherosclerosis. This disease affects all arteries in the human body and is the cause of most cardiovascular pathologies. Degenerative changes gradually occur in the aorta, its diameter increases. Then wall dissection may occur, the formation of blood clots, and their entry into the brain. In the case of ruptured thoracic aortic aneurysm, the mortality rate of patients exceeds 90%. This is due to massive blood loss.
About 20% of patients are diagnosed with genetic syndromes, in which the size of the aorta is reduced due to the decreased strength of the connective tissue. Marfan and Ehlers-Danlos syndromes are the most common among them. Another 15% of patients do not suffer from mutations, but doctors can detect a genetic link: their aneurysms form earlier, grow faster and rupture more frequently.
Rare causes may include:
- Infections.
- Surgery and endovascular procedures.
- Injuries.
Aortic aneurysms develop more often in men. The risk of pathology increases with age.
Symptoms
The thoracic aortic aneurysm does not manifest any symptoms. Aortic enlargement can be detected with the help of instrumental diagnostic methods. However, doctors usually do not conduct any screening for pathology, with the exception of patients suffering from Marfan syndrome.
Due to the asymptomatic course, the disease is often detected only after the development of complications, the most common of which are embolism, dissecting thoracic aortic aneurysm or ruptured thoracic aortic aneurysm.
Diagnostics
The fact of enlarged aorta can be established or suspected using X-ray and ultrasound scanning. Nonetheless, with the help of these methods, the aorta is imagined not completely or not qualitatively enough. Therefore, the main diagnostic methods abroad are CT and MRI scanning.
The doctors measure the diameter of the aorta, since this is the main criterion that determines the treatment tactics. The specialists assess the state of the branches, which are the outgoing arteries of a smaller caliber. Their lesion is an argument in favor of the need for surgery at the borderline markers of the aortic diameter.
With surveillance tactics, the doctors look at how quickly the diameter of the aorta is enlarged, and whether it is enlarged at all. The ascending thoracic aortic aneurysm usually grows slowly – by 1 mm per year, while the descending thoracic aortic aneurysm enlarges 3 times faster.
Who needs surgery
The treatment is required when the risk of ruptured aneurysm increases. The aorta is more likely to rupture if its diameter exceeds 6 cm in the ascending section and 7 cm in the descending section. With a smaller size, rupture can also occur, but very rarely, so the operation is not performed.
In the patients with Marfan syndrome, the operation is performed when:
- Diameter of the aorta reaches 5 cm.
- Diameter of the aorta does not exceed 4,5 cm, but the patient has additional risk factors.
In case of Loeys-Dietz syndrome, the operation is performed with an aortic diameter of 5,5 cm.
With detected borderline markers, the question of the advisability of surgery is considered individually. The doctor takes into account the structure of the patient's body, his height and weight, the presence of risk factors, the rate of aneurysm enlargement, the method of surgical intervention (endovascular treatment is less risky than open surgery).
If necessary, the doctor calculates the indexed aortic diameter. The operation is performed with an indicator of more than 2,75 cm per 1 square meter of body area.
An additional argument in favor of surgical treatment of the aneurysm may be another disease: stenosis or aortic insufficiency. If open valve replacement is planned, then at the same time the doctor can eliminate the aneurysm if the aortic diameter exceeds 4,5 cm.
What operations can be used
Aortic replacement is the main operation for the treatment of the disease. It can be performed using open or minimally invasive techniques.
In case of open surgery, the doctor makes an incision in the thorax and performs the necessary manipulations under imaging guidance. He can do the following manipulations:
- Remove the pathological section of the aorta and implant a vascular prosthesis instead.
- Wrap the dilated vessel with a mesh endoprosthesis.
- Form an anastomosis – a bypass for blood flow.
- Interventions on the coronary arteries and aortic valve can be performed simultaneously.
In terms of efficiency, endovascular aortic replacement is no worse than open aortic prosthesis. The long-term survival of patients is the same. However, the advantage of the endovascular method is low surgical mortality, minimal risk of complications and rapid patient recovery.
During the operation, a stent graft is implanted into the aorta. It is a mesh cylinder covered with a shell. It is imprinted into the vascular wall and strengthens it, thereby preventing rupture. This operation does not require an incision in the thorax. The doctor makes an incision in the leg and delivers the stent to the thoracic aorta through the blood vessels.
The doctors abroad can successfully treat even the most severe cases of aortic aneurysm, when the patient requires replacement of the entire thoracic region, including the ascending and descending aorta, as well as its arch. In such cases, the frozen elephant trunk (FET) procedure is used. It allows the doctors to perform radical replacement of the aortic arch and the ascending aorta, as well as stenting of the descending thoracic aorta using a hybrid prosthesis.
To undergo treatment of aneurysm of the thoracic aorta abroad, please use the Booking Health services. We will help you find the best clinics for the treatment of aortic aneurysm and arrange your trip. On the Booking Health website, you can compare thoracic aortic aneurysm surgery prices and book a medical care program at a favourable price. The cost of treatment for you will be reduced due to the lack of additional coefficients for foreign patients.
Authors:
The article was edited by medical experts, board certified doctors Dr. Nadezhda Ivanisova and Dr. Farrukh Ahmed. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!
Sources:
MedicineNet
Centers for Disease Control and Prevention
Sience Direct
