Thoracic aortic aneurysm or dissection (Thoracic Aortic Aneurysm and Dissection) Although it is not as common as heart disease and stroke, data from the ‘Society of Thoracic Surgeons’ or STS indicate that tens of thousands of patients worldwide die from this condition each year
When acute aortic dissection occurs but is not surgically treated, the mortality rate increases by approximately 0.5% per hour during the first 48 hours after symptom onset, and if not urgently treated within one month, the patient’s chance of death can be as high as 80-90%.
Understanding Thoracic Aortic Aneurysm or Dissection (Thoracic Aorta)
Thoracic aortic aneurysm (Thoracic Aortic Aneurysm) is a condition where a part of the aortic wall abnormally dilates and bulges like a balloon, causing the wall to thin and increasing the risk of rupture.
Meanwhile, thoracic aortic dissection (Thoracic Aortic Dissection) is caused by a tear in the innermost layer of the aortic wall (intimal tear) allowing blood to flow into the wall layers and separate them (false lumen) which may cause branch vessel occlusion and obstruct blood flow to organs such as the brain, heart, or kidneys, or cause the aortic wall to rupture leading to shock from rapid blood pressure drop and death if not urgently treated.
Symptoms and Warning Signs of Thoracic Aortic Aneurysm or Dissection
Most patients have no symptoms or warning signs in the early stages. It is often incidentally found during health check-ups, chest X-rays, or computed tomography (CT scan). When symptoms progress, adjacent organs may be affected by vascular compression, such as airway compression causing breathing difficulty, esophageal compression causing swallowing difficulty, or recurrent laryngeal nerve compression causing hoarseness.
In cases of aortic dissection, patients often develop high blood pressure without abnormal symptoms or may experience sudden severe chest or back pain resembling stabbing or tearing. Other associated symptoms may include dizziness, nausea, sweating, palpitations, and sometimes ischemic symptoms of branch arteries such as hemiplegia, inability to move both legs, or abdominal pain from intestinal ischemia.
Treatment of Thoracic Aortic Aneurysm
Treatment of thoracic aortic aneurysm depends on the size, severity, and location of the affected aorta. If the aneurysm size is below the danger threshold and shows no risk of rupture, such as being smaller than 5 centimeters or growing slowly, doctors will focus on blood pressure control and close monitoring.
If the thoracic aortic aneurysm exceeds the specified size, expands rapidly, or shows severe symptoms such as acute chest or back pain, doctors will consider treatment by open chest surgery (Open Surgery) or endovascular stent graft insertion (TEVAR) without opening the chest, depending on the location of the diseased aorta. For the ascending aorta near the heart, treatment requires sternotomy, but for the descending thoracic aorta, stent graft insertion may be possible.
What is TEVAR Treatment for Thoracic Aortic Aneurysm?
TEVAR (Thoracic Endovascular Aortic Repair) is a treatment method for thoracic aortic disease by inserting a stent graft through the femoral artery to prevent blood from contacting the diseased aortic wall, thus preventing rupture and allowing gradual healing.
During the procedure, the doctor inserts a catheter through the femoral artery to position the stent graft at the abnormal site. The stent is expanded mechanically or with a balloon to fit snugly against the normal aortic wall (landing zone) to block blood flow into the aneurysm area, reinforcing the wall as a new inner lining, allowing blood to flow through the stent graft instead of the damaged wall and preventing rupture.
TEVAR is suitable for patients who cannot undergo traditional open chest surgery or those at high risk from sternotomy and cardiopulmonary bypass, and it is considered the best treatment for descending thoracic aortic disease.
In some complex cases, such as abnormalities in the aortic arch or multiple sites, a hybrid approach may be necessary, combining traditional open surgery with TEVAR to comprehensively and safely address the problem, achieving results comparable to open surgery but with less trauma and fewer early complications.
Advantages of TEVAR Treatment
TEVAR is an endovascular procedure for treating thoracic aortic disease, using device insertion through blood vessels instead of traditional open surgery, with several advantages including
- Safer for high-risk patients such as the elderly or those with comorbidities (hypertension, diabetes, heart disease, kidney disease)
- Reduces risks from open chest surgery such as excessive bleeding, chest infection, or complications from previous scarring
- Reduces risks from general anesthesia
- Faster recovery with shorter hospital and ICU stays
- Reduces infection risk and helps patients return to daily life faster
This technique is therefore an excellent option for patients at high risk for traditional surgery
Limitations of TEVAR Treatment
Although TEVAR has many advantages, it is not suitable for all patients, especially those with anatomical limitations such as
- The affected aortic segment is too small to support the stent graft, increasing the risk of leakage at the graft edges (type 1A) or (B endoleak).
- The thoracic aorta is highly curved or deformed, making stent graft placement difficult or impossible to advance from the femoral or abdominal artery.
- The femoral artery is very small, such as less than 7 millimeters or heavily calcified, making stent graft passage difficult.
After stent graft placement, complications such as endoleak (blood leakage around the graft) or stent migration may occur but can be monitored by computed tomography angiography (CT angiography) for timely detection and management.
Recovery After TEVAR Treatment
Generally, patients are hospitalized for 3-4 days for recovery, with the following recommendations for optimal healing:
- The stent graft is highly durable and does not degrade easily, so long-term use of antiplatelet or anticoagulant drugs is not necessary.
- For 24-48 hours post-surgery, avoid getting the wound wet to prevent infection; waterproof dressings are usually used.
- Within 1-2 days post-surgery, doctors recommend light physical activity such as walking around the bed to stimulate blood circulation and reduce complication risks.
- For the first 3 months post-surgery, avoid strenuous activities such as heavy lifting or intense exercise until cleared by a doctor.
- After returning home, monitor for abnormal symptoms such as severe pain, swelling, redness, excessive wound discharge, difficulty breathing, sudden chest pain, numbness or weakness in the legs, walking difficulties, or fever above 38 degrees Celsius, and seek medical attention promptly.
Patients should strictly control blood pressure and other risk factors such as quitting smoking, controlling blood sugar, maintaining a healthy weight, and adopting healthy behaviors like regular exercise, proper diet, and stress reduction to maximize long-term treatment outcomes.
Thoracic aortic aneurysm and dissection are dangerous conditions with a high risk of sudden death. At the Heart Center, Phyathai 2 Hospital, we prioritize rapid and accurate diagnosis and treatment by a specialized medical team, equipped with advanced treatment technologies such as TEVAR, which enhances treatment effectiveness, reduces complication risks, and promotes rapid patient recovery.
Additionally, patients can choose services tailored to their needs, including comfortable rooms, meal services, and close care from private nurses, along with various facilities to ensure a smooth treatment experience under the concept of Value Healthcare, combining medical quality with cost-effectiveness. Treatment plans can be adjusted to fit the patient’s budget while maintaining international safety standards to ensure the best care at every treatment stage.
Dr. Kittichai Luangtaweeboon
Cardiovascular and Thoracic Surgeon
Heart Center, Phyathai 2 Hospital
