Thoracic Aortic Aneurysm
By Michael Lasalandra
Beth Israel Deaconess Medical Center Correspondent
A pain in her shoulder may have saved Rose Grass's life.
The shoulder pain led Grass to have some X-rays. To her surprise, the pictures indicated she also had something else going on: an abnormality in her chest area. A subsequent chest X-ray and CT scan confirmed she had a thoracic aortic aneurysm, a bulge in the main artery that delivers blood to the entire body.
Such aneurysms can burst without warning, causing instant death.
"I was totally stunned," says Grass, 43, a dental lab technician from Windham, Maine. "It was totally found by accident. I had no idea."
That's how most thoracic aortic aneurysms are found, says
Dr. Marc Schermerhorn, vascular surgeon at The Cardiovascular Institute at Beth Israel Deaconess Medical Center in Boston.
"The most common way is incidentally," he says. "Someone has a CT scan to look at something else."
Occasionally, patients with such aneurysms have back pain, but most often there are no symptoms, he says. As a result, most such aneurysms go undetected until it is too late.
There is no routine screening test for the condition. "You can't do an ultrasound of the chest and chest X-rays don't always detect it," Schermerhorn says. A CT scan to look for a thoracic aortic aneurysm would only be given if there were a family history or if the patient had already been diagnosed with another aneurysm, such as an abdominal aortic aneurysm. Abdominal aortic aneurysms are more common and can be detected by ultrasound. The two types of aortic aneurysms cause 15,000 deaths annually in the U.S.
The most common cause of a thoracic aortic aneurysm is hardening of the arteries, although other risk factors include connective tissue disorders such as Marfan's syndrome, as well as long-standing high blood pressure, or trauma from a fall or accident.
In Grass's case, doctors told her the aneurysm was likely the result of a car accident in which she was involved 20 years ago. "I was in a head-on," she says.
After her diagnosis, doctors in Maine said she didn't need treatment immediately as the bulge was not close to bursting. Treatment options include open-heart surgery to clamp off the aorta and sew a surgical graft in place to prevent the aneurysm from bursting or a newer, minimally invasive technique in which a stent graft made of metal and Teflon is passed through a catheter inserted into the groin and snaked up into the area of the aneurysm. Once inside the aorta, the self-expanding stent graft lines the inside of the blood vessel, strengthening it and easing the pressure that could cause a rupture. The stent procedure is usually indicated for aneurysms of the descending thoracic aorta. Aneurysms of the ascending thoracic aorta usually need surgical repair.
Doctors in Maine recommended Grass have the thoracic stent graft but referred her to Schermerhorn at Beth Israel Deaconess because they had not yet done one of the new procedures. She had the procedure in February, 2006, about a year after her diagnosis.
"We've been doing them for three or four years," Schermerhorn says. "The stent procedure is a lot easier on patients."
At Beth Israel Deaconess, the most complicated thoracic aneurysm cases often involve collaboration between vascular and heart surgeons, Schermerhorn says.
Full open-heart surgery involves cracking the chest, putting the patient on a heart-lung machine and stopping blood flow while the damaged segment of the aorta is replaced, he says.
"Patients are usually in the hospital about two weeks and the recovery can take months," he says.
Grass says she was in the hospital for three days and was back working in a couple of weeks. "It wasn't too bad," she says.
Now, she goes for regular CT scans to make sure everything is alright, and so far all is well. "I should be fine," she says. "Hopefully, this is all I will ever need."
Above content provided by Beth Israel Deaconess Medical Center.
For advice about your medical care, consult your doctor.