Treatment for a thoracic aortic aneurysm depends on its size, location and your overall health. The goals of treatment are to:
- Prevent the aneurysm from growing
- Prevent or reverse damage to other body parts
- Prevent or treat a rupture
- Allow you to continue to go about your normal daily activities.
Watchful Waiting and Medicines
Keep a Close Eye
If your TAA is small and not causing symptoms, your physician at the Cardiovascular Institute may recommend "watchful waiting," which means that you will be monitored over time for signs of changes in your aneurysm. This may require a CT scan or MRI every six months to see if the aneurysm is growing or changing in any way.
Watchful waiting is usually applicable only to aneurysms smaller than about two inches (five centimeters) in diameter. That's about the size of a lemon.
Control High Blood Pressure and Cholesterol
If you also have high blood pressure, your doctor may prescribe a blood pressure medication to reduce the pressure on the weakened area where the aneurysm is located. Your doctor may also prescribe a cholesterol-lowering drug -- often called a "statin" -- to maintain the health of your blood vessels.
Have Regular Checks
But an aneurysm will not go away on its own. If watchful waiting is chosen, it is extremely important to have regular checks to make sure the aneurysm does not grow to a dangerous size over time.
If your TAA is large or causing symptoms, you will need active and prompt treatment to prevent rupture. Your physician at the CVI may recommend treating your aneurysm if it is large, growing quickly or if you have certain other diseases, particularly if you have Marfan's syndrome.
Open Surgical Aneurysm Repair
The traditional and most common type of surgery for a thoracic aortic aneurysm is open surgical repair.
Open surgery requires an incision in the chest and general anesthesia. For ascending and arch aneurysms, the surgeon performs a sternotomy (dividing the breastbone), and for descending aneurysms, the surgeon performs a thoracotomy (incision in the chest through the rib cage).
The operation is usually performed by a cardiac or vascular surgeon and is generally done for aneurysms that are causing pain, are enlarging over time or are already larger than two inches (five centimeters). When deciding on surgery, the doctor considers a variety of factors, including your age, general health, symptoms, size of your aneurysm, and other illnesses you may have.
In the surgery, the aneurysm is taken out and the section of the aorta is replaced with a tube-like artificial graft made of Dacron or Teflon material and shaped and sized just like a healthy aorta. It takes the place of the removed, damaged section of your aorta and allows blood to pass through it easily, without forming a bulge.
Many patients who have a TAA also have heart disease or involvement of the aorta adjacent to the heart. For adjacent or complex thoracic aneurysms, sometimes heart surgery is required at the same time as open aneurysm repair, depending upon the particular situation. For example, valve replacement may also be needed.
Following the surgery, you may stay in the hospital for five to seven days. If your aneurysm is extensive or complex, or if you have other conditions, such as heart disease, your full recovery may take two to three months.
As with any operation, there are risks and you will want to discuss those with your doctor. The good news is that surgeons have been doing this operation for 50 years and 90 percent of open aneurysm repairs are successful in the long-term.
Endovascular Stent Graft Repair
Instead of suggesting traditional open surgery, with its need for a big incision, your surgeon may recommend a newer procedure called an endovascular stent graft. The procedure is less invasive than traditional surgery. It is typically used only for treatment of descending thoracic aortic aneurysms.
The endovascular, or minimally invasive, approach means the treatment is done inside the artery itself using small, thin tubes or catheters that are threaded through the blood vessels. In this procedure, the aneurysm is not removed. The catheter is snaked into place through small incisions made in your groin. During the procedure, your surgeon will use live x-rays that are viewed on a video screen to guide placement of a metal and fabric tube, called an endovascular stent graft (or endograft), to the location of the aneurysm.
The surgeon secures the graft into place by inflating a balloon to expand the graft to the size needed to prevent blood flow into the aneurysm. It is opened up inside the diseased portion of the aorta. The stent-graft both reinforces the weakened part of the vessel from the inside and creates a new channel through which the blood flows, eliminating the risk of rupture. Over time, your aneurysm usually will shrink.
This procedure reduces your hospital stay and recovery time. The procedure itself takes one to three hours, and the hospital stay is reduced to two to three days. However, this treatment, which has been used since 1999, may not be applicable to all TAAs. Your aneurysm must have a suitable shape to allow the stent-graft to be used effectively. At this time, it is generally used for treatment of descending thoracic aneurysms only.
Like any medical procedure, endovascular repair carries risks of complications. It also requires more frequent follow-up visits than open surgery, with regular imaging procedures (usually CT scans) to make sure the graft is continuing to function properly.