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A thoracic aortic aneurysm is a widening (bulging) of part of the wall of the aorta, the body's largest artery.

Aortic aneurysm - thoracic; Syphilitic aneurysm; Aneurysm - thoracic aortic

Thoracic aneurysms most often occur in the descending thoracic aorta. Others may appear in the ascending aorta or the aortic arch.

The most common cause of a thoracic aortic aneurysm is hardening of the arteries (atherosclerosis).

Other risk factors include:

• Connective tissue disorders such as Marfan syndrome
• Having high blood pressure for a long time
• Previous dissection of the aorta
• Syphilis
• Trauma such as falls or motor vehicle accidents

Most patients have no symptoms until the aneurysm begins to leak or expand. Chest or back pain may mean sudden widening or leakage of the aneurysm.

The physical examination is often normal. Most nonleaking thoracic aortic aneurysms are detected by tests -- usually a chest x-ray or a chest CT scan -- run for other reasons. A chest x-ray and chest CT scan show if the aorta is enlarged. A chest CT scan shows the size of the aorta and the exact location of the aneurysm.

An aortogram (a special set of x-ray images made when dye is injected into the aorta) can identify the aneurysm and any branches of the aorta that may be involved.

The long-term prognosis for patients with thoracic aortic aneurysm is determined by other medical problems such as heart disease and diabetes, which may have caused or contributed to the condition.

Serious complications after aortic surgery can include:

• Bleeding
• Graft infection
• Heart attack
• Irregular heartbeat
• Kidney damage
• Paralysis
• Stroke

Death soon after the operation occurs in 5 - 10% of patients.

Complications after aneurysm stenting include damage to the leg, which may require another operation.

Tell your doctor if you have:

• A family history of connective tissue disorders
• Chest or back discomfort

To prevent atherosclerosis:

• Control your blood pressure and blood lipid levels.
• Do not smoke.
• Exercise regularly.

Safi HJ, Estrera AL, Miller CC 3rd, Azizzadeh A, Porat EE. Thoracic vasculature with emphasis on the thoracic aorta. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 63.