Thoracic aortic aneurysm: Optimal surveillance and treatment

Abstract

Aneurysm of the thoracic aorta is less common than in the abdominal aorta, but it is clinically important because of the risk of rupture and death. Cases are often found incidentally. Indications for surgical or endovascular repair are based on aneurysm location and risk factors for rupture such as aneurysm size, rate of growth, and associated conditions, while medical management is also important. Surveillance with various imaging tests is critical before and after intervention to guide treatment. KEY POINTS Patients with bicuspid aortic valve or genetic syndromes such as Marfan syndrome are at higher risk, with lower thresholds for surgical intervention, but account for only a minority of cases. Although echocardiography has some roles in screening and monitoring the aortic root and ascending aorta, computed tomography and magnetic resonance imaging are necessary for the complete assessment of the thoracic aorta and are often necessary for surveillance. Guidelines from several professional societies are available regarding surveillance and indications for intervention. Patients with thoracic aortic aneurysm require multidisciplinary care, including a cardiologist and possibly a cardiovascular surgeon and genetic counselor. Medical care includes traditional cardiovascular risk factor management. Beta-blockers are often used to control blood pressure but should be used with caution in those with acute aortic valve regurgitation.

Huge Thoracic Aortic Aneurysm Presenting with Jaundice: A Case Report

“…5 Atherosclerosis along with its risk factors, connective tissue disease (eg, Marfan syndrome), and abnormalities of the aortic valve (eg, bicuspid aortic valve) are strongly associated with the development of ascending aortic aneurysms, but sporadic cases have also been reported. 10,11 The majority of TAAs are asymptomatic, and identifying a patient with them represents a true challenge to health care providers. 4,5 TAA can be encountered during a routine radiological examination, as an acute presentation with dissection, as a part of screening the relative of a patient with a known aneurysm, or as a part of a known congenital cardiac defect.…”

“…1 Frequently reported symptoms of thoracic aortic aneurysm include dyspnea, cough, dysphagia, hoarseness of voice, claudication, cerebrovascular events, as well as chest, abdominal, or back pain. 11 Other unusual presentations of thoracic aneurysms reported in the literature include erosion of the overlying skin and sternum, rupture into the esophagus, compression and invasion of the pulmonary artery, superior vena cava syndrome, and recurrent laryngeal and phrenic nerve palsy. [12][13][14][15]17,18 The most common causes of jaundice are choledocholithiasis, biliary strictures, carcinoma of the head of the pancreas, pancreatitis, and sclerosing cholangitis.…”

“…18 To diagnose these aneurysms, the clinical history should be focused on the symptoms, risk factors, family history, and followed by detailed physical examination looking for signs of aneurysmal dilatation or its complications. 11 Aortic imaging with echocardiography, computed tomography angiography, and magnetic resonance angiography remain the cornerstone to diagnose aortic aneurysms. 11 Screening with transesophageal echocardiography is reasonable to evaluate the aorta in predisposed populations (eg, connective tissue disorders, bicuspid aortic valve, or screening first-degree relatives of patients with TAA).…”

Holt-Oram syndrome, bicuspid aortic valve, and patent ductus arteriosus

“…Redo intervention on the AA (and possibly BAV replacement) after previous surgery may increase the peri-procedural risk (EuroSCORE II 2.88). Nonetheless, systematic assessment of the dilated AA is recommended every 6-12 months [5]. Finally, a more than casuistic coexistence of HOS and BAV may not be proven nor excluded in this case.…”

Optimal surveillance and treatment of renal and splenic artery aneurysms

“…In a previous article, 1 we discussed the optimal surveillance strategies and treatment for aneurysm of the thoracic aorta. Here, we address the diagnosis, surveillance, and treatment of renal artery and splenic artery aneurysms.…”