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Thoracic aortic aneurysm


Expert reviewer, Mark Yeatman, Cardiothoracic surgeon
Next review due August 2020

A thoracic aortic aneurysm is when the aorta, which is the largest blood vessel in your chest (thorax), bulges outwards, at least doubling in size. It’s a serious condition that needs to be monitored closely because if the aneurysm bursts (ruptures), it can be fatal.

An image showing thoracic aortic aneurysm

About thoracic aortic aneurysm

Your aorta is the artery (blood vessel) that carries blood from your heart to the rest of your body, branching off to other blood vessels. It travels through your chest, where it’s called the thoracic aorta, and down into your abdomen where it becomes the abdominal aorta. Normally, your aorta is about 2 to 3cm (about an inch) wide.

If you have a weak spot in your aorta, it can cause it to get wider and create an aneurysm. If this happens in the part of the aorta that goes through your chest, it’s called a thoracic aortic aneurysm. If it’s in the aorta as it goes through your abdomen, it’s called an abdominal aortic aneurysm. We have a separate topic on abdominal aortic aneurysm. You can have more than one aneurysm at the same time.

About four in 100 people over 65 develop a thoracic aortic aneurysm, and your risk of getting one increases as you get older. They’re more common in men than in women.

Symptoms of thoracic aortic aneurysm

You’re unlikely to have any symptoms of a thoracic aortic aneurysm unless it bursts open (ruptures) or the aorta lining tears. But if it starts to expand and push on surrounding tissue or nerves in your chest, you might get:

  • chest pain, or pain in your neck, back, or the top of your stomach
  • difficulty breathing or shortness of breath
  • coughing
  • wheezing
  • hoarseness
  • difficulty swallowing

If one of the layers of the aorta wall tears or ruptures, you may get sudden and severe, sharp pain in your chest, or in your back. Some people say this feels like they’re having a heart attack.

If the pain in your chest is really bad, and you have any of these other symptoms, seek urgent medical attention. If the aneurysm does rupture, it may cause severe internal bleeding. This could be fatal if you don’t have emergency surgery to repair it.

Diagnosis of thoracic aortic aneurysm

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

Your GP or doctor in hospital will examine you and ask you about your medical history. If they think you have a thoracic aortic aneurysm, you may have other tests in hospital, which may include the following.

  • A computer tomography (CT) or magnetic resonance imaging (MRI) scan. These will produce 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 and where it is.
  • A transthoracic echocardiography 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 pipe that goes from your mouth to your stomach). This can also show an image of your heart and thoracic aorta.

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 your aneurysm is small (less than 5.5cm), you won’t usually need to have treatment but it depends on your circumstances and what’s caused the aneurysm. But you’ll need regular scans, usually every six months, to see if your aneurysm gets any bigger. Usually they’ll grow slowly so if your doctor keeps an eye on your aneurysm you can get treatment before it’s likely to rupture.

Self-help

If you have a thoracic aortic aneurysm and it’s being monitored, there are some things you can do to help yourself.

Take some steps to change your lifestyle to combat anything that increases your risk of the aneurysm getting bigger. This might be getting help for a condition that may be causing the aneurysm, such as high blood pressure. If you smoke, try to quit, and lose weight if you need to. And take steps to lower your cholesterol.

See Related information for tips and advice on how to achieve these.

Surgery

Your doctor will suggest you have surgery if your aneurysm is:

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

They’ll also suggest surgery if you have Marfan syndrome and your aneurysm is 5cm or more, or you have a family history of aneurysms. If you have Marfan syndrome and other things that increase your risk of an aneurysm bursting, you might need to have surgery when it’s smaller. For more information about this condition, see our FAQ: Marfan syndrome below.

Other health conditions can also warrant surgery before your aneurysm gets to 5.5cm. These include if you have a condition called bicuspid aortic valve, in addition to other risks. A bicuspid aortic valve is a heart condition that you’re usually born with, which affects the aorta. You might also need surgery earlier if you have a family history of an aneurysm tearing.

You’ll 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

In open surgery for a thoracic aortic aneurysm, your surgeon will open your chest to reach your aorta. They’ll then put a graft into the weak area of your aorta. This is usually a synthetic graft that’s made out of an elastic material. Blood will flow through the graft inside your aorta instead of through the aneurysm, which will prevent the aneurysm getting any bigger.

Keyhole surgery

It’s also possible to have keyhole surgery to treat a thoracic aortic aneurysm, and this is called endovascular aneurysm repair (EVAR). In this procedure, your surgeon will feed a tube through an artery in your groin and up through your aorta to the aneurysm. They’ll put a stent through this tube and into your artery. Your surgeon will take CT images before your operation, and use X-ray images during it, to guide them to put the stent in the right place. The stent will be covered with synthetic graft material that will bond with the wall of your aorta. Blood will then flow through the stent instead of the aneurysm.

Stents aren’t suitable for everyone. It depends on where your aneurysm is and your general health, as well as other things. Ask your doctor or surgeon for more information and if it’s an option for you.

For more information on both open and keyhole surgery for a thoracic aortic aneurysm, see our separate topic: Aortic aneurysm surgery.

Causes of thoracic aortic aneurysm

You can get a thoracic aortic aneurysm if the wall of your aorta weakens, which causes it to bulge outwards. Doctors don’t know exactly why this happens but think it’s probably due to a number of things.

Some people with a thoracic aneurysm have atherosclerosis. This is where fatty deposits build up on the inside of your arteries, which weaken the artery walls.

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

  • are involved in an accident that injures your aorta
  • are a man (they’re more common in men than women)
  • smoke
  • have a family history of aneurysms or atherosclerosis
  • have high blood pressure
  • are overweight
  • have Marfan syndrome (to learn more about this see our FAQ: Marfan syndrome), or another type of what’s called a connective tissue disorder
  • have chronic obstructive pulmonary disease (COPD)
  • have an infection, such as HIV
  • have chronic (long-lasting) kidney disease
  • have a problem with your heart valve that’s connected to your aorta

Complications of thoracic aortic aneurysm

A thoracic aortic aneurysm can burst if the weakened artery wall of your aorta can't contain the pressure of the blood inside. The chance of an aneurysm rupturing depends on its size. If your aneurysm is more than 5.5cm wide, the chances of it rupturing are high. The risk increases as the aneurysm gets bigger. This is a really serious situation – it’s usually fatal unless you get treatment in time. It’s important to have regular check-ups and change your lifestyle to help prevent this from happening.

Here’s what you can do to prevent your thoracic aortic aneurysm from rupturing.

  • Make sure you go to check-ups to monitor your thoracic aortic aneurysm if your doctor asks you to.
  • If you smoke, get some help to quit. Your GP surgery might have some information about the support available.
  • If you have high blood pressure, take steps to lower it. Along with taking medicines, losing weight and exercising can help with this.

See Related information for advice on making these changes. There may be local services in your area that can help you to achieve your goals too.

Other complications of a thoracic aortic aneurysm can include the following.

  • Heart valve problems, leading to 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), which can stop your heart pumping properly and cause heart failure.
  • Aortic dissection. If the inner lining of your aorta tears, blood will enter into the wall of the aorta. If this happens, you may feel sudden and severe chest and back pain.

Prevention of thoracic aortic aneurysm

You can take steps to reduce your risk of getting a thoracic aneurysm, or atherosclerosis that might lead to it (see Causes), by:

  • not smoking
  • having your blood pressure and cholesterol checked regularly, and getting treatment if necessary
  • exercising regularly
  • keep to a healthy weight
  • eating a healthy diet

See Related information for tips and advice on how to make these changes.

It’s important to have regular medical check-ups if you have a family history of arterial disease.

Frequently asked questions

  • Marfan syndrome is a condition that affects the way your body produces the elastic fibres that make up the connective tissue in your body.

    More information

    People with Marfan syndrome have a defect in a gene that controls the production of elastic fibres in their body. The elastic fibres (connective tissue) hold your joints and organs in place and help control how your body grows. Because connective tissue is found throughout your body, the effects of Marfan syndrome can be widespread. It can involve your heart, lungs, skeleton, skin and eyes, for example.

    About three in 10,000 people have Marfan syndrome. You can inherit the condition from one of your parents if they have Marfan syndrome. But not everybody who gets Marfan syndrome inherits it.

    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. You’ll probably need to take medicines, such as beta blockers, to make your heart beat more slowly and with less force, and have regular scans.

  • You can drive if you have an aortic aneurysm (thoracic or abdominal), but you may need to tell the DVLA (Driver and Vehicle Licensing Agency) about your aneurysm. Whether you can drive or not will also depend on the type of vehicle you drive and the size of your aneurysm. There are also slightly different rules if you have Marfan syndrome.

    It’s important to talk to your specialist doctor about whether it’s safe to drive or not. It’s also worth checking with your insurer to see if they have any specific recommendations.

    Always follow your doctor’s advice and if you’re unsure about anything, ask.


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Related information

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  • Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, August 2017
    Expert reviewer, Mark Yeatman, Cardiothoracic surgeon
    Next review due August 2020



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