Thoracic Aortic Aneurysm Repair
The treatment plan for a thoracic aortic aneurysm (TAA) depends on its size, growth rate, location and your general health. If the aneurysm is small and you have no symptoms, your physician may suggest a conservative medical approach that would typically include regularly scheduled diagnostic tests to check the aneurysms size and strict monitoring of your blood pressure and diet. If your aneurysm is large enough, or if the aneurysm is growing more than 0.5 centimeter per year, your surgeon will most likely recommend surgery as your best option.
The conservative approach to treatment is typically used for aneurysms that are smaller than about two inches across. If you also have high blood pressure, your physician may prescribe blood pressure medication to lower your overall blood pressure and the pressure on the weakened area of the aneurysm.
If your TAA is large, causing symptoms, growing quickly or your health is compromised for other reasons, your surgeon may recommend active and prompt treatment to prevent rupture. If you have Marfan's syndrome, you may require active treatment sooner than patients who have small TAAs but do not have Marfan's syndrome.
The active treatments for TAA are open surgical aneurysm repair and endovascular stent-graft repair.
Open Surgical Repair
During open aneurysm repair, your surgeon makes an incision in your chest and replaces the weakened portion of your aorta with a fabric tube, called a graft. The graft is stronger than the weakened aorta and allows blood to pass through it without causing a bulge. Many patients who have a TAA also have heart disease or involvement of the aorta adjacent to the heart. For extensive or complex thoracic aneurysms, sometimes heart surgery is required at the same time as open aneurysm repair depending upon the particular situation.
The operation, including the incision that is made, depends on the location of the aneurysm. If the aneurysm is close to the aortic valve, an incision in the front of the chest such as a median sternotomy may be used. If the aneurysm is close to the valve, the aortic valve may have to be repaired or replaced. Surgery on the aortic arch is usually done from the front as well. If the aneurysm involves the descending thoracic aorta, which lies in the left chest, or the thoracic abdominal aorta, an incision on the left side of the chest will likely be required. If the aneurysm is confined to the abdomen, then an incision either in the abdomen, or on the side or flank may be used.
Following the surgery, you may stay in the hospital for five to 10 days. If your aneurysm is extensive or complex, or if you have other conditions such as heart, lung or kidney disease, you may require two to three months for a complete recovery.