Thoracic aortic aneurysm - Wikipedia, the free encyclopedia

6/15/15, 22:14

Thoracic aortic aneurysm

From Wikipedia, the free encyclopedia

A thoracic aortic aneurysm is an

aortic aneurysm that presents
primarily in the thorax.

Thoracic aortic aneurysm

A thoracic aortic aneurysm is the

"ballooning" of the upper aspect of
the aorta, above the diaphragm.
Untreated or unrecognized they can
be fatal due to dissection or
"popping" of the aneurysm leading to
nearly instant death. Thoracic
aneurysms are less common than an
abdominal aortic aneurysm.[1]
However, a syphilitic aneurysm is
more likely to be a thoracic aortic
aneurysm than an abdominal aortic
aneurysm.

Thoracic aortic aneurysm with arrow marking the lateral border of the aorta.
Classification and external resources
ICD-10

I71.1
(http://apps.who.int/classifications/icd10/browse/2015/en#/I71.1),
I71.2
(http://apps.who.int/classifications/icd10/browse/2015/en#/I71.2)

ICD-9

441.1 (http://www.icd9data.com/getICD9Code.ashx?
icd9=441.1), 441.2
(http://www.icd9data.com/getICD9Code.ashx?icd9=441.2)

Contents
1 Causes
1.1 Age
1.2 Risk factors
2 Screening
3 Treatment
4 Complications
5 Epidemiology
6 References

Causes

MedlinePlus 001119
(http://www.nlm.nih.gov/medlineplus/ency/article/001119.htm)
eMedicine

article/761627 (http://emedicine.medscape.com/article/761627overview) article/424904

(http://emedicine.medscape.com/article/424904-overview)
article/418480 (http://emedicine.medscape.com/article/418480overview)

MeSH

D017545 (https://www.nlm.nih.gov/cgi/mesh/2015/MB_cgi?
field=uid&term=D017545)

There are a number of causes, [2]

Aneurysms in patients younger than 40 usually involve the ascending aorta due to a weakening of the aortic
wall associated with connective tissue disorders like the Marfan and Ehler-Danlos syndromes or congenital
bicuspid aortic valve. Younger patients may develop aortic aneurysms of the thoracoabdominal aorta after an
aortic dissection. It can also be caused by blunt injury.
Atherosclerosis is the principal cause of descending aortic aneurysms, while aneurysms of the aortic arch may
be due to dissection, atherosclerosis or inflammation.
https://en.wikipedia.org/wiki/Thoracic_aortic_aneurysm

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Age
The diagnosis of thoracic aortic aneurysm usually involves patients in their 60s and 70s.

Risk factors
Hypertension and cigarette smoking are the most important risk factors,
though the importance of genetic factors has been increasingly
recognized. Approximately 10% of patients may have other family
members who have aortic aneurysms. It is also important to note that
individuals with a history of aneurysms in other parts of the body have a
higher chance of developing a thoracic aortic aneurysm.[3]

Screening
Guidelines were issued in March 2010 for early detection of thoracic
aortic disease, by the American College of Cardiology, the American
Heart Association, and other groups. Among the recommendations:

A contrast enhanced CT
demonstrating a large thoracic
aneurysm of about 7 cm which has
ruptured.

First-degree relatives of people with thoracic aortic aneurysm or

dissection should have aortic imaging to identify asymptomatic
disease.
People with symptoms suggestive of thoracic aortic dissection
should be routinely evaluated "to establish a pretest risk of disease that can then be used to guide
diagnostic decisions."
People diagnosed with Marfan syndrome should immediately have an echocardiogram to measure the
aorta, and followed up 6 months later to check for aortic enlargement.[4]

Treatment
The size cut off for aortic aneurysm is crucial to its treatment. A thoracic
aorta greater than 4.5 cm is defined as aneurysmal, while a size greater
than 6 cm is the distinction for treatment, which can be either
endovascular or surgical, with the former reserved for pathology at the
descending aorta.[5]
Indication for surgery may depend upon the size of the aneurysm.
Aneurysms in the ascending aorta may require surgery at a smaller size
than aneurysms in the descending aorta.[6]
Treatment may be via open or via endovascular means.

Complications
https://en.wikipedia.org/wiki/Thoracic_aortic_aneurysm

A stent graft placed in the thoracic

aorta to treat a thoracic aortic
aneurysm.

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The principal causes of death due to thoracic aneurysmal disease are dissection and rupture. Once rupture
occurs, the mortality rate is 5080%, and most deaths in patients with the Marfan syndrome are the result of
aortic disease.

Epidemiology
Each year in the United States, some 45,000 people die from diseases of the aorta and its branches. Acute aortic
dissection, a life-threatening event due to a tear in the aortic wall, affects 5 to 10 patients per million population
each year, most often men between the ages of 50 and 70; of those that occur in women younger than 40, nearly
half arise during pregnancy. The majority of these deaths occur as a result of complications of thoracic
aneurysmal disease.

References
1. Thoracic Aortic Aneurysm (http://emedicine.medscape.com/article/424904-overview) at eMedicine
2. Aneurysms: Aneurysms and Aortic Dissection (http://www.merck.com/mmhe/sec03/ch035/ch035b.html) at Merck Manual
of Diagnosis and Therapy Home Edition
3. Thoracic Aortic Disease - Northwestern Memorial Hospital. Thoracic Aortic Aneurysm
(http://www.nmh.org/nm/vascular-disease-thoracic-aortic-disease)
4. Hiratzka LF, Bakris GL, Beckman JA et al. (April 2010). "2010
ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the diagnosis and management of patients with
thoracic aortic disease. A Report of the American College of Cardiology Foundation/American Heart Association Task
Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology,American
Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and
Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons,and Society for Vascular Medicine"
(http://content.onlinejacc.org/cgi/content/full/j.jacc.2010.02.010v1). J. Am. Coll. Cardiol. 55 (14): e27e129.
doi:10.1016/j.jacc.2010.02.015 (https://dx.doi.org/10.1016%2Fj.jacc.2010.02.015). PMID 20359588
(https://www.ncbi.nlm.nih.gov/pubmed/20359588).
5. Makaroun MS, Dillavou ED, Kee ST et al. (January 2005). "Endovascular treatment of thoracic aortic aneurysms: results
of the phase II multicenter trial of the GORE TAG thoracic endoprosthesis"
(http://linkinghub.elsevier.com/retrieve/pii/S0741521404014855). J. Vasc. Surg. 41 (1): 19.
doi:10.1016/j.jvs.2004.10.046 (https://dx.doi.org/10.1016%2Fj.jvs.2004.10.046). PMID 15696036
(https://www.ncbi.nlm.nih.gov/pubmed/15696036).
6. "Treatment Considerations related to Thoracic Aortic Aneurysm" (http://www.mayoclinic.org/aorticaneurysm/thoracictreatment.html). Retrieved 2010-10-23.

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Categories: Diseases of the aorta Diseases of arteries, arterioles and capillaries Vascular diseases
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