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Descending Thoracic and Thoracoabdominal Aortic Aneurysm

Ourania Preventza, MD, Joseph S. Coselli, MD
Descending Thoracic and Thoracoabdominal Aortic Aneurysm is a topic covered in the Adult and Pediatric Cardiac.

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Abstract

Aortic aneurysm involves localized dilatation of the aorta to a diameter at least 50% greater than normal, posing a risk of malperfusion, dissection, and rupture. Aneurysms of the descending thoracic aorta (DTAs) and of the thoracoabdominal aorta (TAAAs) are most commonly caused by degenerative disease processes (eg, atherosclerosis, medial degenerative disease), but there are other acquired, congenital, and iatrogenic causes as well. Symptoms are highly variable, and imaging techniques (most often computed tomography, less frequently magnetic resonance imaging) can be useful. Intervention is indicated when an aneurysm reaches a certain threshold of diameter or rate of expansion; these thresholds vary according to whether the patient has symptoms, chronic aortic dissection, or a connective tissue disorder. In cases requiring intervention, endovascular repair is preferred for DTA, whereas for TAAA, open surgical repair remains the gold standard. Hybrid repair is also possible for TAAA but does not have clear advantages over open repair. Postoperatively, patients require regular surveillance imaging for anastomotic leaks, pseudoaneurysm at suture lines, disease progression, and dissection.

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Abstract

Aortic aneurysm involves localized dilatation of the aorta to a diameter at least 50% greater than normal, posing a risk of malperfusion, dissection, and rupture. Aneurysms of the descending thoracic aorta (DTAs) and of the thoracoabdominal aorta (TAAAs) are most commonly caused by degenerative disease processes (eg, atherosclerosis, medial degenerative disease), but there are other acquired, congenital, and iatrogenic causes as well. Symptoms are highly variable, and imaging techniques (most often computed tomography, less frequently magnetic resonance imaging) can be useful. Intervention is indicated when an aneurysm reaches a certain threshold of diameter or rate of expansion; these thresholds vary according to whether the patient has symptoms, chronic aortic dissection, or a connective tissue disorder. In cases requiring intervention, endovascular repair is preferred for DTA, whereas for TAAA, open surgical repair remains the gold standard. Hybrid repair is also possible for TAAA but does not have clear advantages over open repair. Postoperatively, patients require regular surveillance imaging for anastomotic leaks, pseudoaneurysm at suture lines, disease progression, and dissection.

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Last updated: September 15, 2020