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Thoracic aortic aneurysms: clinical features and indications for surgery 

Thoracic aortic aneurysms: clinical features and indications for surgery
Chapter:
Thoracic aortic aneurysms: clinical features and indications for surgery
Author(s):

Rachel E. Clough

and Peter R. Taylor

DOI:
10.1093/med/9780199658220.003.0056
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date: 22 September 2019

Most descending thoracic aortic aneurysms (TAA) are asymptomatic, being discovered incidentally on chest X-rays and computed tomography scans. TAAs can rupture into the oesophagus, bronchial tree, mediastinum, or the pleural space. Investigations include cross-sectional imaging to define the extent of the aneurysm and the involvement of important side branches. Imaging also determines the suitability for endovascular repair. Elective patients should have a full assessment of cardiac, pulmonary, and renal function which can influence both short- and long-term survival. If the risks of rupture are higher than those of intervention the aneurysm should be repaired. Symptomatic aneurysms should be repaired urgently and ruptured aneurysms with haemodynamic instability treated as an emergency. The main complications of repair are death, stroke, and paraplegia. The risk of paraplegia can be reduced by maintaining systemic blood pressure and reducing cerebrospinal fluid pressure with a drainage catheter in the sub-arachnoid space.

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