What is a Thoracic Aortic Aneurysm (TAA)?

TAAs often develop without causing any symptoms until they rupture. Only about 5% of people have symptoms.

When symptoms do appear, they may include:

• difficulty swallowing or hoarseness
• pain in your chest or back
• cough
• shortness of breath

If left untreated, the aneurysm can lead to a tear in the inner layer of your aorta, which is called an aortic dissection. They can also lead to a full aortic rupture.

An aortic dissection or rupture is a life threatening medical emergency. It’s critical to get medical attention if you develop any symptoms of a potential rupture such as:

• sudden severe pain that may spread to your neck, jaw, or back
• loss of consciousness
• weakness
• paralysis on one side
• sudden trouble breathing

TAAs occur due to a weakness in the wall of your aorta. They most commonly develop in the part of your aorta closest to your heart.

Syphilis was the leading cause of aortic aneurysms before the invention of antibiotics. These days, they’re usually caused by very high blood pressure or sudden injury.

In about 20% of people with TAAs, their TAAs are linked to genetic syndromes inherited from their parents. Some genetic syndromes associated with TAAs include:

• Marfan syndrome
• Ehlers-Danlos syndrome
• Loeys-Dietz syndrome
• Turner syndrome

Additionally, 16 genes have been identified so far that may predispose you to disease of your thoracic aorta.

Risk factors for TAA include:

• a history of smoking
• coronary artery disease
• high blood cholesterol
• connective tissue disorders such as Marfan syndrome
• family history
• male sex
• increased age
• chronic obstructive pulmonary disease
• previous aortic aneurysm

An unruptured TAA is usually discovered through imaging tests such as chest X-rays for unrelated conditions.

If a doctor or healthcare professional suspects you might have a problem with your heart or aorta, they’ll likely send you for imaging tests. You might receive:

• an echocardiogram
• a CT scan
• cardiac magnetic resonance imaging (MRI)
• positron emission tomography (PET) scans

The most widely used test to diagnose TAA is a contrast-enhanced CT scan. During this procedure, you’ll be given a special dye either by mouth or through an injection to help make your blood vessels more visible on a CT scan.

TAAs require prompt treatment to minimize your risk of a life threatening rupture. Depending on how large an aneurysm is, a doctor may recommend:

• regularly monitoring the aneurysm every 6 months to a year with imaging
• medications
• preventive or emergency surgery

Medications

Medications can help lower pressure around your aneurysm and reduce the chances of it rupturing.

Beta-blockers are first-line drugs used to decrease blood pressure and stress on the aorta. Many people can take beta-blockers with mild or no side effects. Some potential side effects include:

• shortness of breath
• fatigue
• feeling sick
• lightheadedness

Other medications that may be used to manage TAAs include:

• angiotensin receptor blockers and angiotensin-converting enzyme inhibitors
• statins and other lipid-lowering agents
• glucocorticoids
• indomethacin
• leukocyte-depleting antibody

Surgery

Emergency surgery is vital for a ruptured aneurysm. A doctor may recommend preventive surgery if an aneurysm is at risk of rupturing in the future.

The American College of Cardiology and American Heart Association recommend preventive surgery if the aneurysm is in the ascending aorta and greater than 5.5 centimeters (cm), or 2.17 inches (in), across. Or, if it’s in the descending aorta and greater than 6.0 cm (2.4 in) across.

Three types of surgery are used to treat TAAs:

• TAA open repair: An incision is made in your chest or back so the surgeon can access your aorta and repair the aneurysm. This surgery has a high risk of mortality.
• Aortic stent graft: A metal mesh coil is inserted through an artery in your groin. X-rays are used to visualize its position in your aorta so that it covers the aneurysm.
• Complex aortic stent graft: The procedure is similar to an aortic stent graft, but the metal mesh has holes in it to allow blood to flow to arteries branching off your aorta.

In a large study, researchers found the risk of aortic dissection was 0.22 per 100 people per year, with a bigger dissection size associated with a higher risk.

If a TAA ruptures, it’s fatal in more than 90% of people. More than 22% of people die before reaching the hospital.

Treating a TAA early before it requires emergency surgery gives you the best chance of having a positive outcome.

The 5-year survival rate for those who have preventive surgery is about 85%, but it’s only about 37% in people who have emergency surgery.

In another study, researchers found people who underwent preventive surgery for TAAs in the ascending aorta and survived the postoperative period regained their full life expectancy. The researchers reported the following survival rates for preventive surgery:

The majority of TAAs aren’t linked to family history. That’s why making lifestyle changes may help reduce your risk of this condition. Some ways that you may be able to prevent aneurysms include:

• quitting smoking
• keeping your blood pressure under control
• eating a balanced diet
• minimizing your intake of trans fats and highly processed foods
• getting a screening evaluation if you have a family history

Certain groups of people can benefit from screening for a TAA such as:

• people with a genetic syndrome associated with TAAs such as Marfan syndrome
• people with a parent or sibling with a TAA or bicuspid aortic valve-associated TAA

A thoracic aortic aneurysm (TAA) is characterized by an abnormal widening in your aorta. TAAs in most people are associated with trauma or very high blood pressure.

TAAs almost always cause death if they rupture. Treating them early before they rupture is critical for improving your outlook. It’s a good idea to talk with a doctor about screening for a TAA if somebody in your family has had a TAA or if you have a genetic syndrome associated with TAAs.