A thoracic aortic aneurysm is a pathological dilation of the aortic wall in its thoracic segment, which may lead to rupture, dissection, or other life-threatening conditions. Treatment is aimed at preventing aneurysm rupture, stabilizing its growth, and reducing the risk of complications.
Main approaches to the treatment of thoracic aortic aneurysm in Belarus
- Conservative management. Drug therapy and regular follow-up for small aneurysms.
- Surgical treatment. Open surgical intervention for large aneurysms or in the presence of symptoms.
- Endovascular treatment (TEVAR). Minimally invasive placement of a stent graft.
- Prevention of complications. Blood pressure control and lifestyle modification.
Indications for treatment
Conservative management
- Aneurysm diameter less than 5.5 cm in men and less than 5.0 cm in women.
- Absence of symptoms (asymptomatic aneurysm).
- Slow growth rate (less than 0.5 cm per year).
Surgical or endovascular treatment:
- Aneurysm diameter greater than 5.5 cm (or greater than 5.0 cm in women).
- Rapid increase in size (more than 0.5 cm per year).
- Presence of symptoms (chest or back pain, impaired breathing or swallowing).
- Risk of rupture or dissection.
- Hereditary connective tissue disorders (e.g., Marfan syndrome, Ehlers–Danlos syndrome).
- Preparation for other cardiac surgical procedures.
Pharmacological therapy:
Comprehensive use of medications to control symptoms and prevent complications.
Lifestyle recommendations:
- Blood pressure control (<130/80 mmHg).
- Cessation of smoking and alcohol consumption.
- Moderate physical activity; avoidance of heavy lifting.
- Low-fat, low-salt diet.
Regular follow-up:
-
CT, MRI, or ultrasound imaging every 6–12 months to monitor aneurysm size.
Surgical treatment
Open surgical repair:
-
Replacement of the affected segment of the aorta with a synthetic vascular graft.
Indications:
- Large aneurysm size.
- Rapid progression.
- Symptomatic aneurysms or imminent risk of rupture.
Advantages:
-
Long-term durability and effectiveness.
Limitations:
- Requires open surgical access and general anesthesia.
- Prolonged recovery period.
- Higher risk in patients with significant comorbidities.
Endovascular treatment (TEVAR)
TEVAR (thoracic endovascular aortic repair):
-
A minimally invasive procedure in which a stent graft is introduced via the femoral artery to reinforce the aortic wall from within.
Advantages:
- Suitable for patients with high surgical risk.
- Faster recovery.
- Reduced risk of aneurysm rupture.
Limitations:
- Not suitable for all aneurysm anatomies (e.g., severe aortic tortuosity).
- Requires lifelong imaging follow-up to monitor stent graft integrity.
Prevention of complications
- Blood pressure control. Regular use of antihypertensive medications.
- Atherosclerosis prevention. Maintenance of normal cholesterol and blood glucose levels.
- Reduction of physical strain. Avoidance of heavy lifting and sudden movements.
- Infection prevention. Use of antibiotics before invasive procedures in patients with vascular prostheses (for prevention of infective endocarditis).
Treatment of a thoracic aortic aneurysm depends on its size, growth rate, and the presence of symptoms. Small aneurysms are usually managed conservatively with medication and regular monitoring. For large or symptomatic aneurysms, open surgical repair and TEVAR remain the main treatment options. Early detection, strict blood pressure control, and adherence to medical recommendations significantly reduce the risk of complications and help prolong patient survival.
