II. Definitions
- Thoracic Aortic Aneurysm
- Widened diameter of the thoracic aorta at least 1.5 times greater than normal thoracic aorta
III. Epidemiology
- Incidence: 6-10 per 100,000 persons (approximately 15,000 persons in U.S. per year)
IV. Risk Factors
- Marfan Syndrome
- Loeys-Dietz Syndrome
- Family History of Aortic Dissection
V. Types
- Location
- Aortic Root or ascending aorta (60%)
- Aortic Arch (10%)
- Descending Aorta (40%)
- Thoracoabdominal Aorta (10%)
- Shape
- Fusiform (uniform shape)
- Saccular (bulbous on one side)
VI. Complications
-
Thoracic Dissection
- See Thoracic Dissection for risk factors
VII. Management: Control risk factors to prevent Aortic Dissection
VIII. Management: Surgery Indications
- Asymptomatic patients without underlying conditions
- Diameter >5.5 cm in asymptomatic patient AND one of the following
- Degenerative aortic aneurysm
- Chronic Aortic Dissection
- Intramural Hematoma
- Penetrating atherosclerotic ulcer
- Mycotic aneurysm
- Pseudoaneurysm
- Diameter <5.5 cm in asymptomatic patient AND
- Increase in ascending aortic diameter >0.5 cm/year
- Diameter >5.5 cm in asymptomatic patient AND one of the following
- Ascending Thoracic aorta or aortic sinus diameter in Collagen vascular disorder
- Diameter >4.2 cm by echo (>4.4 to 4.6 cm by CT or MRI) in asymptomatic Loeys-Dietz Syndrome
- Diameter >4 cm in asymptomatic Marfan Syndrome patient desiring pregnancy
- Diameter >4 to 5 cm in asymptomatic Marfan Syndrome patient
- Especially if Family History of Aortic Dissection, increase in ascending aortic diameter >0.5 cm/year
- Asymptomatic patients with bicuspid aortic valve
- Diameter >5.5 cm in asymptomatic patient with bicuspid aortic valve
- Diameter >5.0 cm in asymptomatic patient with bicuspid aortic valve AND
- Family History of Aortic Dissection
- Increase in ascending aortic diameter >0.5 cm/year
- Diameter >4.5 cm in bicuspid aortic valve undergoing aortic Valve Replacement