What is a Thoracic Aortic Aneurysm?
Your aorta is a large blood vessel that runs from your heart through your chest and belly. It supplies blood to all parts of your body. The aorta can become weak from disease or damage which can cause a bulge (aneurysm) to form in the blood vessel wall. If it is in your chest it is called a thoracic aortic aneurysm. If it is in your belly it is called an abdominal aortic aneurysm.
Some of the risks for getting an aneurysm are:
- Atherosclerosis (a buildup of plaque in the blood vessel wall)
- High blood pressure
- Increased age
- Male gender
- High Cholesterol
- Family history of aneurysms
- Bicuspid aortic valve
How is an aneurysm found?
Aneurysms are sometimes seen on routine chest x-rays taken for other health reasons. Once an aneurysm is found, you will have more testing which may include:
- CT scan – this is the Gold Standard for monitoring your aorta. This scan requires the use of contrast dye. If you cannot undergo a CT scan, other imaging will be used.
- Echocardiography (ultrasound of your heart)
You will also be referred to a specially trained doctor (cardiac surgeon) to review these tests and help choose a care plan that is right for you
How are thoracic aortic aneurysms treated?
Treating your risk factors may help stop the aneurysm from growing. Your doctor may prescribe treatment to improve your:
- Blood pressure
- Cholesterol levels
- Blood sugar
Keeping active is very good for your heart health. Walking, running, swimming and riding your bike are good forms of exercise. Check with your family doctor before starting a new exercise routine. Avoid heavy weight lifting or any activity that causes you to strain.
Your doctor may suggest that the best treatment for your aneurysm right now is to “watch and wait”. You will have tests on a regular basis to check the size of your aneurysm. If your aneurysm reaches a certain size or you start to have symptoms, the surgeon may then suggest that the aneurysm needs to be repaired. There are two methods to repair an aneurysm. The surgeon will suggest the best treatment based on your age, health and the location of the aneurysm.
What is an endovascular repair?
The surgeon will insert a stent-graft through a large blood vessel in your groin. The graft is guided into place within the aneurysm using a wire and x-ray. Once the graft is in the correct place, it is expanded inside the blood vessel to cover the aneurysm and make a new path for the blood to flow through. This is called a TEVAR which stands for thoracic endovascular aortic repair. This procedure can take 2 to 3 hours and most patients can go home in a few days. Most people return to normal activities within 1 to 2 weeks. More information will be given to you at your clinic appointment if a TEVAR is the treatment plan for you.
What is an open surgical repair?
A cut is made in your chest where the aneurysm is. The bulging section of the blood vessel is replaced with a graft. After the grafting the new section will work like a normal blood vessel. The surgery can take many hours. You will need to stay in hospital for about 7 to 10 days. Most people return to normal activities within about 4 to 6 weeks. We will give you more information at your clinic appointment if your surgeon thinks that this is the best treatment option for you.
While you “watch and wait”
Please call your family doctor or the Manitoba Thoracic Aortic Clinic (Monday to Friday 0730-1545 hours) at 204 258-1811 if you have questions or concerns about your aortic disease
Sign of an aortic emergency
When an aneurysm gets too large, it can tear and/or rupture causing life-threatening bleeding. A blood clot may also form in an aneurysm. A small piece of a blood clot may break off and travel to other parts of the body and cause a stroke or a heart attack. Call 911 or your local emergency number if you have:
- Sudden severe pain in your chest (may radiate to your back or abdomen)
- Feeling dizzy or faint
- Trouble breathing or shortness of breath
- Pain, numbness, coldness, weakness or if you cannot move your arms, legs, or buttocks
- Rapid heartbeat
- Slurred speech
- New bladder or bowel problems such as: trouble passing urine, loss of bowel or bladder control or constipation
If your surgeon suggests either to “watch and wait” or to have your aneurysm repaired, you will need to have regular follow up visits. How often you are seen and how often you will need to have routine tests will depend on your treatment plan. Please go to all tests and appointments asked for by the Manitoba Thoracic Aortic Team. You can do a lot to help improve your health:
- Quit smoking
- Exercise regularly (after checking with your family doctor)
- Eat a heart healthy diet
- Maintain a healthy weight
- Take your medications as prescribed
For more information about aortic disease and treatment, please visit Thoracic Aortic Disease Coalition http://www.tadcoalition.org/about/