Thoracoabdominal Aortic Aneurysm (TAAA)

Thoracoabdominal aortic aneurysm (also called TAAA or T triple-A) is swelling and weakness in the aorta's wall that is extended from the chest into the abdomen. The aorta is the body's major blood vessel that carries blood from the heart to the rest of the body. A thoracoabdominal aortic aneurysm can rupture which results in life-threatening and uncontrollable bleeding.

The abdominal aorta is the most common location for an aneurysm. The most severe cases include the aorta's thoracic and abdominal parts. Aneurysms are caused primarily by calcification (atherosclerosis), degeneration caused by an imbalance between the proteins that create the vessel walls and those that break them down, genetic factors and inflammation.

Causes & Risk Factors

The most prevalent cause of thoracoabdominal aortic aneurysms is atherosclerosis, which is the stiffness of the arteries caused by plaque formation. This plaque can stiffen and damage the aorta's walls over time, increasing the chance of an aneurysm formation.

Some of the risk factors for atherosclerosis and thus for developing a thoracoabdominal aortic aneurysm are:

Smoking
High blood pressure
High cholesterol
Overweight
Family history of cardiovascular disease

Other risk factors for developing thoracoabdominal aortic aneurysm include:

Old age
Gender (Males are more likely to be affected than females)
Family history of aneurysm
Diabetes
Marfan syndrome, Ehlers-Danlos syndrome, and Loeys-Dietz syndrome are examples of genetic disorders affecting connective tissue.
Aortic infection or injury

Symptoms of Aortic Aneurysm

Thoracoabdominal aortic aneurysms commonly develop without symptoms, but some may include:

Pulsating lump in the abdomen
Intense pain in the abdominal, chest or lower back which develops unexpectedly

The following are symptoms of a ruptured thoracoabdominal aortic aneurysm:

Decrease in blood pressure
An increased heart rate
Lightheadedness or dizziness
Extreme pain

Diagnosis

After reviewing your complete medical history and performing a physical exam, your doctor may request any of the following tests:

CT (computed tomography) scan
MRI (magnetic resonance imaging) scan
Angiography
Echocardiography

Treatment

Close Monitoring Period

During the "close monitoring" period, the vascular surgeon will perform a series of CT or MRI scans or ultrasounds to monitor the aneurysm's growth every 6 - 12 months. Once an aneurysm has grown to a significant size and is at risk of bursting, the surgeon might perform the procedure. The benefits of repairing the aneurysm outweigh the risks and complications of the surgery.

When an aneurysm reaches a size that places it at risk of rupture, the surgical alternatives are evaluated based on several criteria, including:

Age of the patient, previous medical and surgical history, and present health status
Age of the patient, previous medical and surgical history, and present health status
Type, location, and size of an aneurysm
Anatomy of the aorta and the arteries that branch off it to the visceral organs and the legs

The type of procedure used depends on the patient's medical condition and the aneurysm's characteristics.

Conventional Open Procedure

An abdominal aortic aneurysm needs opening the abdominal cavity and stitching a synthetic graft inside the aneurysm to the artery above and below it to prevent the aneurysm from collapsing while relining the weaker aorta with a material sleeve to bolster the aorta.

Endovascular Repair

Endovascular repair is a recent method that involves inserting a catheter into the groin. The catheter is used to place a self-expanding stent graft into the aneurysm, similar to an aortogram. Endovascular aneurysm treatment does not require a major incision and has a significantly quicker recovery time than conventional open surgery. Endovascular repair is not appropriate for all aneurysms.

Frequently Asked Questions

1. What size abdominal aortic aneurysm (AAA) requires surgery?

If you develop a AAA that is over 5.5cm in maximum diameter (about 5 cm in women), surgery is usually recommended. The risk of rupture is frequently higher than the risk of surgery for these larger aneurysms. If you have a family history of aneurysm rupture, surgery is also likely to be recommended.

2. How do you stop an aortic aneurysm from growing?

The most important thing you can do to delay the progression of an aneurysm is to keep your blood pressure under control. If you have high blood pressure, the extra force pushes against the aneurysm's walls, causing it to enlarge.

3. Can an abdominal aneurysm heal itself?

Abdominal aortic aneurysms wouldn't go away on their own, so if you have a large one, surgery may be required. The aneurysm is replaced with a man-made graft during the surgery. Elective surgery, performed before an aneurysm ruptures, has a success rate of over 90%.

4. How serious is an aneurysm in the aorta?

The most common consequences are tears in one or more layers of the aortic wall (aortic dissection) or a ruptured aneurysm. Internal bleeding might be fatal if a rupture occurs. The greater the aneurysm's size and rate of growth, the greater the risk of rupture.

5. Can you live a normal life with an aortic aneurysm?

Yes, you may live with an aortic aneurysm, and there are several ways to avoid dissection (a split in the blood artery wall that allows blood to leak) or, much worse, rupture (a burst aneurysm)

5. What foods to avoid if you have an aortic aneurysm?

The following are some popular foods that are unhealthy for your aortic health:

Fatty meats, such as red meat.
Fried foods.
Refined, white carbohydrates.
Sugary drinks, such as soda.
Fatty oils, such as margarine and butter.

7. Can stress cause an aortic aneurysm?

High blood pressure increases strain on the aorta's inner wall. This stress might cause the blood vessel wall to bulge over time. This is the most important determinant in the development of thoracic aortic aneurysms.

8. What should I avoid after an aneurysm diagnosis?

For 3 months or until your doctor says it's acceptable, avoid intense activities like cycling, jogging, weight lifting, or aerobic exercise.

9. What vitamins help aneurysm?

Individuals at high risk of CA formation and/or rupture should eat plenty of antioxidant vitamins (vitamin C, vitamin E, and carotenoids), B vitamins (vitamin B6, vitamin B12, and folate), flavonoids, and n-3 fatty acids while avoiding alcohol and caffeine to keep their blood pressure under control.