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Thoracic Aortic Aneurysms

The thoracic aorta is divided into three segments: ascending aorta, aortic arch and descending aorta. An aneurysm may be located in one of these areas and/or may be continuous throughout the aorta. A patient's diagnosis and treatment will depend upon the location of the aneurysm. The specialists at the University of Chicago Center for Aortic Disease are experts in diagnosing and treating thoracic aneurysms.
 

Types of Thoracic Aneurysms

Ascending: A widening of the vessel wall in the portion of the aorta located closest to the heart. Ascending aneurysms can also cause additional heart conditions, such as a dissection, heart attack or stroke.

Descending: A weakening or bulging of the descending aortic wall, located in the back of the chest cavity.

Thoracoabdominal: An aneurysm that extends throughout the aorta, from the chest to the abdomen.

Symptoms and Causes of Thoracic Aortic Aneurysms

Thoracic aortic aneurysms are slow growing and often asymptomatic, which makes them difficult to identify. Some patients with aneurysms might experience pain or discomfort such as:

  • Pain in the jaw, neck, and/or upper back
  • Wheezing, coughing or shortness of breath due to pressure on the trachea (windpipe)
  • Hoarseness as a result of compression on the vocal cords
  • Difficulty swallowing (dysphagia) because of stress on the esophagus


The occurrence of pain often is associated with an imminent rupture of the aneurysm. Acute, sudden onset of severe pain in the back and/or abdomen may represent rupture and is a life-threatening medical emergency that would necessitate an immediate trip to the hospital.

Causes

Several factors can lead to the development of a thoracic aneurysm, including genetic disorders or other health problems. Common causes include:

  • Cystic medial degeneration (necrosis), which is breaking down of the tissue of the aortic wall.
  • Genetic disorders that affect the connective tissue, such as Marfan syndrome and Ehlers-Danlos syndrome
  • Family history
  • Atherosclerosis, which is a hardening of the arteries caused by a build-up of plaque in the inner lining of an artery. This is common for descending aneurysms, but is a rare cause of ascending thoracic aortic aneurysm
  • Infection, such as syphilis

Treatment Options:

Our vascular surgeons are experts at managing complex aortic conditions and offer a wide variety of advanced options. The best course of treatment will depend on the size and location of the aneurysm.

Medical Management

  • Lifestyle changes, such as smoking cessation and dietary modifications
  • Medications to control factors such as hyperlipidemia or high blood pressure
  • Observation to monitor aneurysm growth over time

Surgical Options

Open or endovascular repair: A traditional or minimally invasive technique used to correct thoracic and abdominal aneurysms.

Valve-sparing root replacement: The aortic valve is repaired while preserving the valve's integrity, avoiding the need for a valve replacement with a prosthetic valve.

Biological composite aortic graft
: The aortic root and valve is replaced with a bio-prosthetic valved conduit. This has a number of potential advantages, including the avoidance of the need for blood thinning medications.

Homograft root replacement
: In the setting of severe infection, the aortic root is reconstructed using cadaveric human (homograft) aorta. This decreases the risk of reinfection, eliminates the need for blood thinning medication. 

Ross procedure: The patient's own pulmonary valve is used to replace the aortic valve, and a pulmonary allograft (valve taken from a cadaver) is then used to replace the patient's pulmonary valve.

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