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Thoracic aortic aneurysm

A thoracic aortic aneurysm is a widening or bulging of the aorta in your chest (thorax). It’s a serious condition that needs to be monitored closely because if the aneurysm bursts (ruptures), it can be fatal.

Your aorta is the big blood vessel that carries all the blood that’s pumped out of your heart. The aorta runs upwards from your heart before curving downwards through your chest (the thoracic aorta) and into your abdomen (the abdominal aorta).

The aorta is usually 2 to 3cm (about one inch) wide. A weak spot in your aorta can cause it to bulge. This is called an aneurysm. If the bulge is in the part of the aorta that goes through your chest, it’s called a thoracic aortic aneurysm. If it occurs in the aorta as it goes through your abdomen, it’s called an abdominal aortic aneurysm.

You can have more than one aneurysm at the same time.

Most people who get a thoracic aneurysm are over 50. They’re more common in men than in women. As many as four in one hundred people over 65 develop a thoracic aortic aneurysm, and the risk increases with age

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An image showing thoracic aortic aneurysm


  • Symptoms Symptoms of thoracic aortic aneurysm

    You’re unlikely to have any symptoms of a thoracic aortic aneurysm unless it bursts or the aorta lining tears. However, if it starts to expand and push on surrounding tissue or nerves in your chest, a thoracic aortic aneurysm can cause:

    • chest pain
    • back pain
    • difficulty breathing
    • coughing
    • wheezing
    • hoarseness
    • difficulty swallowing

    These symptoms aren’t always caused by a thoracic aortic aneurysm. If you’re worried about any of them or if you have chest pain, contact your GP.

    If a tear appears in one of the layers of the aorta wall, you may feel a severe, sharp pain in your chest. This is sometimes confused with a heart attack.

    If a thoracic aortic aneurysm ruptures, this is extremely serious and usually fatal.

  • Diagnosis Diagnosis of thoracic aortic aneurysm

    You probably won’t have any symptoms of a thoracic aortic aneurysm. If it’s expanding quickly, you may have some chest pain. An aortic aneurysm is usually discovered during tests for chest pain or tests you’re having for another reason.

    If your GP suspects that you have a thoracic aortic aneurysm, you may have other tests in hospital, which may include the following.

    • A CT or MRI scan can provide images of your thoracic aorta. They are very useful for finding the exact position of the aneurysm.
    • A chest X-ray may show a widening of your aorta.
    • A transthoracic echocardiography is a test in which an ultrasound sensor is placed over your chest. This can show an image of your heart and thoracic aorta.
    • A transoesophageal echocardiography test. This involves passing a small ultrasound sensor into your oesophagus or gullet (the food pipe that goes from your mouth to your stomach).
  • Treatment Treatment of thoracic aortic aneurysm

    Your treatment for a thoracic aortic aneurysm will depend on your symptoms and the size of your aneurysm.

    Watchful waiting

    If you have a small aneurysm, you won’t usually have surgery but you will need regular ultrasound checks to see if your aneurysm is growing. It’s also important to manage your condition by changing your lifestyle and treating the cause of the aneurysm, such as high blood pressure.


    Your doctor will advise you to have surgery if your aneurysm is:

    • larger than 5.5cm
    • expanding quickly
    • causing pain or other symptoms, such as difficulty breathing

    Or if you have Marfan syndrome or a family history of aneurysms.

    You will need to have emergency surgery if your aneurysm ruptures or leaks.

    There are two main types of operation for a thoracic aortic aneurysm.

    Open surgery

    Open surgery for aortic aneurysm involves your surgeon opening your chest to reach your aorta. They will then insert a graft into the weak area of your aorta. The graft may be synthetic and made out of a knitted or woven material. Blood will flow through the graft inside your aorta instead of through the aneurysm. This prevents the aneurysm getting bigger.

    Endovascular stent graft replacement

    Endovascular aneurysm repair (EVAR) involves your surgeon feeding a stent through the femoral arteries in your groin. The stent will go up through your aorta to the area of the aneurysm. A stent is a tube covered with synthetic graft material. Your surgeon will use X-ray images to guide the placement of the stent.

    The graft material will bond with the arterial wall and blood will flow through the stent instead of the weakened aneurysm. Stents aren’t suitable for everyone. It depends on the location of the aneurysm and other factors. Ask your doctor for more information.

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  • Causes Causes of thoracic aortic aneurysm

    A thoracic aneurysm develops when the wall of your aorta weakens, which causes it to bulge. Doctors don’t know exactly why the aorta weakens in some people. Some people with a thoracic aneurysm have atherosclerosis. This is a process in which fatty deposits build up on the inside of your arteries and weaken the artery walls.

    You’re more likely to develop an aneurysm if you:

  • Complications Complications of thoracic aortic aneurysm

    If the aneurysm ruptures it may cause severe internal bleeding. This will be fatal without emergency surgery to repair it. The chance of an aneurysm rupturing depends on its size and location in your aorta. If your aneurysm is greater than 5.5cm wide, the chances of rupture are high. The risk increases with increasing size.

    If your thoracic aneurysm ruptures you will get severe pain in your chest. If you have this symptom, you must seek urgent medical attention.

    Complications of a thoracic aortic aneurysm can include the following.

    • Heart failure. If the aneurysm happens near your heart it may cause the aortic valve to leak. This can cause blood to flow back into your heart (aortic regurgitation), stopping your heart pumping effectively and causing heart failure.
    • Aortic dissection. The inner lining of your aorta can tear and blood will enter into the wall of the aorta. If this happens, you may feel sudden and severe chest and back pain.
  • Prevention Prevention of thoracic aortic aneurysm

    You can take steps to reduce your risk of developing an aneurysm by:

    • not smoking
    • keeping your blood pressure and cholesterol well controlled
    • exercising regularly
    • maintaining a healthy weight
    • eating a healthy diet

    If you have a family history of arterial disease you should have regular check-ups so that your GP can advise you how to prevent problems.

  • FAQs FAQs

    What is Marfan syndrome?


    Marfan syndrome is a condition that affects the way your body produces the fibres that make up the connective tissue in your body. For example, between your joints and organs.


    People with Marfan syndrome have a defect in a gene that controls the production of connective tissue in their body. The connective tissue holds your joints and organs in place and helps control how your body grows. Because connective tissue is found throughout your body, the effects of Marfan syndrome can be widespread, and involve your heart, lungs, skeleton, skin and eyes.

    About one in 5,000 people have Marfan syndrome. People can inherit the condition, meaning that they get it from a parent who also has the syndrome.

    If you have Marfan syndrome, you’re more at risk of getting an aortic aneurysm because the elastic tissue of your aorta isn’t produced correctly. This makes your aorta weaker so it can widen more easily.

    What are the risks of open surgery versus endovascular aneurysm repair (EVAR) for treating thoracic aortic aneurysm?


    Endovascular aneurysm repair (EVAR) may have fewer risks during and straight after the operation than open surgery. However, there isn’t enough research to know which type of operation is better in the long term. EVAR isn’t suitable for everyone.


    Like all major surgical procedures, surgery to repair a thoracic aortic aneurysm carries a risk of complications. These include paralysis, bleeding and stroke. The risk of these complications depends on your specific circumstances.

    EVAR reduces the risk of complications during and straight after the procedure. However, there are additional problems that can happen after EVAR that don’t happen after open surgery. People who have this operation need to have more regular check-ups than those who have open surgery.

    There isn’t enough research to know which type of operation is better in the long term. Talk to your doctor or surgeon for more advice.

    How long does it take to recover from open surgery for thoracic aortic aneurysm?


    You can expect to be in hospital for around a week. A full recovery usually takes at least six weeks.


    People respond to surgery differently. Many factors, including your age and general state of health, will affect how quickly you recover from the procedure. If you smoke, it will slow down your recovery. Talk to your surgeon for more information.

  • Resources Resources

    Further information


    • Thoracic aortic aneurysm. Patient UK Professional Reference., published 13 June 2012
    • Thoracic aortic aneurysm. eMedicine., published 19 November 2014
    • Hole JR, Koos KA. Human anatomy. Dubuque, Iowa: Wm C Brown; 1994:25–26
    • Thoracic aortic aneurysm. Patient UK Professional Reference., published 16 May 2012
    • Simon C, Everitt H, van Dorp F and Burkes M. Oxford handbook of general practice. 4th ed. Oxford: Oxford University Press; 2014
    • Ruptured abdominal aortic aneurysm. Patient UK Professional Reference., published 16 May 2012
    • Echocardiogram. British Heart Foundation., accessed 25 February 2015
    • NHS Abdominal Aortic Aneurysm Screening Programme. Care Pathway., accessed 25 January 2015
    • Endovascular stent-graft placement in thoracic aortic aneurysms and dissections. National Institute for Health and Care Excellence (NICE), 2005.
    • Ramrakha P, Hill J. Oxford handbook of cardiology. 2nd ed. Oxford: Oxford University Press, 2012. doi:10.1093/med/9780199643219.001.0001
    • CVD risk assessment and management. Risk Factors for CVD. NICE Clinical Knowledge Summaries., published September 2014
    • Marfan syndrome. Patient UK Professional Reference., published 10 December 2013
    • Abraha I, Romagnoli C, Montedori A, Cirocchi R. Thoracic stent graft versus surgery for thoracic aneurysm. Cochrane Database of Systematic Reviews 2013, Issue 9. doi:10.1002/14651858.CD006796.pub3
    • Open AAA repair. The Circulation Foundation., accessed 3 May 2015
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