Thoracic Aneurysm Treatment & Management

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

Prehospital Care

In patients with symptoms suggestive of thoracic aortic aneurysm (TAA), prehospital care should consist of ensuring adequate airway and breathing, providing oxygen via a nonrebreather mask, placing 2 large-bore intravenous lines, and providing continuous cardiac monitoring.

Patients who are unstable (often those with a ruptured aneurysm or dissection) may require airway protection, mechanical ventilation, and aggressive fluid resuscitation. Timely communication between prehospital care providers and the receiving hospital is important in ensuring that the proper resources are available and brought to bear rapidly.

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Emergency Department Care

Initial stabilization includes the following:

  • Placing 2 large-bore intravenous lines, administering 100% oxygen, and providing a cardiac monitor
  • Monitoring urine output

Consider alternate diagnoses. Until the diagnosis of thoracic aortic aneurysm (TAA) is established, be vigilant for other causes of symptoms, such as myocardial infarction (MI), aortic insufficiency, CHF, or pulmonary embolus.

Provide aggressive blood pressure control. Beta-blockers and nitrates are commonly used. [3]

For patients who are hemodynamically unstable, provide the following:

  • Aggressive fluid resuscitation (including blood products)
  • Placing an arterial line in the right radial artery (or in the left radial artery, if the systolic blood pressure on the left is higher), especially in patients who may have dissection or in those who are receiving intravenous nitroprusside and/or esmolol
  • Correction of coagulopathy
  • Immediate surgical consultation
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Consultations

Immediately consult with a cardiac surgeon (for ascending aorta or arch) or with a vascular surgeon (for descending aorta) for patients who are hemodynamically unstable or for patients with symptoms of a thoracic aneurysm. Anesthesia and operating room personnel need to be contacted in cases where emergent operative procedures are indicated.

Consult with a vascular surgeon or a cardiac surgeon and a radiologist to determine the optimal studies for assessing the anatomy of the thoracic aneurysm.

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