Thoracic Aortic Aneurysm

• What is a thoracic aortic aneurysm?

  Dilation of the thoracic aorta

  Most commonly affects ascending aorta

  Normal diameter = > 4.5 cm (ascending), > 3.5 cm (descending)

  Extremely high mortality
• What are the RFs for thoracic aortic aneurysms?

  Men

  Increased age

  Smoking

  HTN

  FHx

  Existing CVD

  Marfan syndrome (or other connective tissue disorders)
• What are the signs & symptoms of thoracic aortic aneurysms?

  Often asymptomatic

  Chest/back pain

  Cough

  SOB

  Stridor

  Hiccups (due to phrenic nerve compression)

  Dysphagia

  Hoarse voice
• What are the Inx for thoracic aortic aneurysms?

  Obs

  Full Hx & examination

  ECG

  Bloods (FBC, CRP, ABG/VBG, LFTs, U&Es, coag, group & save)

  Echo

  CT angio
• What is the management of thoracic aortic aneurysms?

  Stop smoking

  Healthy diet & exercise

  Optimise HTN, diabetes & hyperlipidaemia

  Regular monitoring the size

  Thoracic endovascular aortic repair (TEVAR)

  Open surgery
• What are the possible complications of thoracic aortic aneurysms?

  Aortic dissection

  Ruptured aneurysm

  Aortic regurgitation (if aortic valve is affected)
• The risk of rupture increases with the diameter of the aneurysm.
• How does a ruptured thoracic aortic aneurysm present?

  Severe chest/back pain

  Haemodynamic instability (hypotension/tachycardia)

  Syncope

  Death
• What is the management of a ruptured thoracic aortic aneurysm?

  Initial stabilisation

  Emergency open surgery w/ replacement of the affected section of the aorta with a synthetic graft