Thoracic Aneurysm Follow-up

Updated: Oct 01, 2015
  • Author: Bret P Nelson, MD; Chief Editor: Erik D Schraga, MD  more...
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Follow-up

Further Inpatient Care

Unstable patients with thoracic aortic aneurysm (TAA) usually require medical or surgical ICU admission for careful hemodynamic monitoring.

Patients who are symptomatic require admission, as do those in whom a final diagnosis is uncertain.

Some patients with complicating conditions, such as Marfan syndrome or another cardiovascular disease, may require admission for medical stabilization and for more urgent surgical repair, even if they are asymptomatic at presentation.

Indications for surgical repair include the following: [4]

  • Rupture
  • Acute dissection (ascending requires urgent intervention, whereas descending is managed medically or surgically, if vascular complications arise)
  • Symptomatic states, including pain, mediastinal organ compression, or aortic insufficiency severe enough to cause CHF or a dilated hypokinetic left ventricle
  • Rapid aneurysm growth rate
  • Absolute size (5.5 cm for ascending aortic aneurysm, 6.0 cm for descending aortic aneurysm; in patients with Marfan syndrome, 5.0 cm for ascending aortic aneurysm, 6.0 cm for descending aortic aneurysm)

Surgical and other interventional options for TAA repair include the following: [3]

  • Open approaches using cardiopulmonary bypass, hypothermia, and grafting
  • Endovascular stent grafting may be an option when TAA is limited to the descending aorta.
  • Complications of repair include paraplegia, renal failure, and intraoperative mortality.
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Transfer

Patients with TAA who are symptomatic should only be transferred via advanced life support (ALS) system if the sending facility is unable to provide appropriate operative care.

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Complications

Complications of thoracic aortic aneurysm include the following:

  • Rupture of the TAA into the mediastinum, pleural space, trachea, or esophagus
  • Dissection
  • Aortic insufficiency
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Prognosis

In a series of 370 patients with TAA, survival at 1, 5, and 10 years were found to be 88%, 69%, and 56%, respectively. [5]

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Patient Education

For patient education resources, see the Heart Health Center and Aortic Aneurysm.

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