The Methodist Aortic Center provides an advanced specialty care for patients in our San Antonio and South Texas areas performing the most current treatments and surgeries for abdominal aortic aneurysm and thoracic aortic aneurysm.
Aortic Aneurysm Overview
An aortic aneurysm is an abnormal enlargement of the wall of the aorta causing the walls to weaken. The aorta is the major blood vessel that carries blood from your heart to your body and is about a foot long and over an inch in diameter. The ascending portion of the aorta rises about 2 inches from its exit point on the left ventricle and gives off branches to supply the heart. It then curves downward giving off branches that supply blood to the head, neck and arms.
Aneurysms can occur anywhere along the aorta and in some cases an individual may have both types of aneurysms:
- Abdominal aorta aneurysm occurs through the portion that passes through the abdomen
- Thoraric aorta aneurysm occurs through any portion that runs the entire length of the chest which supplies blood to structures in the chest
The wall can continue to enlarge or remain unchanged. It is important to monitor this closely. If the bulge continues to grow, the wall can become much weakened that it can cause tearing or dissection and cause life-threatening bleeding.
Thoracic aortic aneurysms usually grow slowly and do not present with symptoms making it very challenging to detect. Some aneurysms will never rupture but many enlarge over time. How quickly an aneurysms grows is hard to predict but is important in determining the best option for treatment.
Patients will show up with ER with one or many of the following symptoms, and the cardiologist in the ER will have CT scan. The radiologist will then call the cardio ER doc and will have to triage the patient and admitting into hospital.
Symptoms usually occur when the aneurysm compresses on surrounding structures causing chest pain, back pain, cough, hoarseness, difficulty breathing, difficulty swallowing.
Patients who experience sudden tearing chest or back pain sometimes associated with pain in the jaw and neck, nausea and vomiting, raising heartbeat, dizzy or generally feeling unwell may be experiencing a tearing of the aorta and need immediate evaluation.
Other signs and symptoms that suggests aneurysm rupture are low blood pressure, loss of consciousness, weakness/difficulty speaking or other signs of a stroke.
- Long term tobacco use
- Traumatic injury
- Degenerative diseases of the aortic wall that is related to aging
- Atherosclerosis or plaque build-up in the walls
- Genetic conditions such as Marfan syndrome, Ehlers-Danlos, Loeys-Dietz and Turner syndromes
- Inflammatory conditions like giant cell arteritis and Takayasu’s arteritis
The goal of the treatment is to prevent the aneurysm from growing or surgery before it dissects or ruptures. Medication and monitoring are important interventions prior to surgical repair. Surgery is recommended based on the size and location of the aneurysm, and it’s rate of growth. Monitoring may require regular imaging studies to detect the rate of growth of the aneurysm. A CT scan or MRA every six month or so depending on cause, size and rate of growth of the aneurysm. Medications to control blood pressure, reduce cholesterol levels are critical to management.
Surgical repair is generally recommended if your thoracic aortic aneurysm is about 5 to 6 centimeters and larger. Your surgeon may recommend patients with Marfan syndrome or other connective tissue disease that have a higher risk of having an aortic dissection undergo repair for smaller sized aneurysms.
Most people with thoracic aortic aneurysm will have an open chest repair. Endovascular repair may be recommended to select patients.