Thoracic aortic aneurysm

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Thoracic aortic aneurysm 


This leaflet explains about thoracic aortic aneurysms. If you have any further questions 

or concerns, please contact the nurse case managers on 020 7188 1025 / 1085. 


The aorta 

The aorta is the main artery (vessel that 

carries oxygen-rich blood to the body) 

that comes of the left side of your heart. 

It comes out of the heart upwards 

(ascending aorta) and then arches 

backwards (aortic arch) and 

downwards (descending aorta) through 

the chest into the abdomen (abdominal 

aorta) and into the arteries in the legs – 

see Figure 1, right above. 

Thoracic aorta 

Descending aorta 



The thoracic aorta 

Abdominal aorta 

The thoracic aorta is the section of the 

aorta that is in the chest. The aorta 

continues on below this into the 

abdomen. At the bottom of the 

ascending aorta is the aortic valve. This 

opens to allow blood to be pumped 

through it and then closes to prevent 

the blood going back towards the heart. The 

heart, the aortic valve and the aorta all work 

together. See Figure 2, righ

Figure 1 – The aorta 

t below. 


What is an aortic aneurysm? 

An aortic aneurysm is when part of the aorta 

bulges or balloons out, usually where the wall 

of the aorta is weak. The normal width of the 

thoracic aorta is 2.8–4.5cm. This can vary 

with age, and weight. When the aorta is 1.5 

times the size of the normal aorta, it is 

diagnosed as an aortic aneurysm. See 

Figure 3 on page 2. With time an aneurysm 

may get larger, which can cause problems 

(see ‘Complications of thoracic aortic 

aneurysms’ below).  


An aneurysm can develop at any point along 

the aorta. The types of aortic aneurysm are 

Figure 2 – The thoracic aorta 


divided according to where they occur. The most 

common place is in the abdomen (called an 

abdominal aortic aneurysm or AAA). In this case, the 

problem will be dealt with by vascular surgeons 

(specialising in arteries and veins). An aneurysm that 

occurs in the chest (called a thoracic aortic aneurysm 

or TAA) is dealt with mainly by cardiac surgeons 

specialising in the heart). They will often deal the 

roblem jointly with vascular surgeons. 




What causes an aortic aneurysm? 

The blood in the aorta is under pressure as it is 

pumped from the heart. The wall of this artery has to 

be strong enough to resist this pressure, but still 

flexible enough to return to its normal shape when 

after a pulse of blood has passed through. An 

aneurysm (bulging of the aorta) usually occurs where 

the wall has become weak and has lost its elastic 

properties, so it doesn’t return to its normal shape. 

See Figure 3 right.  

Figure 3 – Normal thoracic aorta (left) 

compared with aortic aneurism (right) 


The causes that lead to a weakened aortic wall and aneurysm include: 


  weakening of the artery wall from smoking or high blood pressure 

  tearing of the artery wall (dissection) as a result of high blood pressure 

  arteriosclerosis (a condition where arteries become clogged up by fatty substances) 

 ageing 

  congenital weakness of the artery wall (something you are born with) 

  inherited conditions such as Marfan syndrome (a rare disorder affecting connective 


  trauma (usually from falls or motor vehicle accidents). 


Sometimes the cause of an aneurysm is not clear. Unless they are caused by trauma, they do 

not develop suddenly but over several years. 


What are the signs and symptoms? 

A thoracic aneurysm is often found accidentally during investigations for other medical 

conditions. You might not have experienced any symptoms, or will have had some, but not 

associated them with this condition. Some symptoms may occur as a result of the aortic 

aneurysm pressing on their surrounding structures, including: 


  pain in the jaw, neck, and upper back 

  chest or back pain 

  a persistent cough 

 hoarseness, 

 difficulty 





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What treatments are available? 

The treatment you receive will depend on a number of factors, such as the size of the aneurysm 

and its location. If you have not had a computerised tomography (CT) scan then, we (or your 

referring hospital) may request for you to have this so we can assess this information. Our aortic 

team will assess the CT images and we will ask you to attend a clinic to meet an aortic cardiac 

surgeon and/or aortic vascular surgeon, to discuss your treatment and management plan.  


There are three main treatments / management plans that the consultant may discuss with you. 

These are outlined over the page. The plan will be individual to you, taking into account your 

general health, medical history, views and beliefs. 



If your TAA is small, your surgeon may recommend ‘watchful waiting’. This means you will be 

monitored with echocardiograms (scans used to look at the heart and nearby blood vessels also 

– called ‘echos’) and CT scans. They will be carried out every six or 12 months, to see if there 

are signs of changes in your aneurysm. If your aneurysm is being monitored, it is because the 

surgeon has reviewed the images and feels that the aneurysm isn’t large enough to need 

surgery. How fast the aneurysm grows (if at all) varies depending on the individual. Your 

surgeon will tell you when they think you need surgery.  



If your TAA is large (5 to 5.5cm or larger) and is causing symptoms, or if you have a hereditary 

condition such as Marfan’s syndrome, your surgeon may recommend that the section of aorta 

with the aneurysm is surgically replaced. This will be performed by open heart surgery, meaning 

the chest is cut open. The section of the aorta that has the aneurysm is then removed and 

replaced by a new aorta that is made from a man-made (synthetic) material. The material  

causes very few reactions, does not have harmful chemicals, and easily tolerated by the body.  


For more information on the procedure, please ask the surgeon. 


If we decide you should have this surgery, we will give you more information and ask you to 

attend a pre-operative clinic, where we will carry out a series of tests to prepare you for surgery. 

We will give you time to ask any questions and address any concerns you might have before 

your admission. If you wish to find out more information about heart surgery please see our 

leaflet Having heart surgery.  



A stent is a tube that is surgically inserted into an artery to allow blood to flow freely. Depending 

on where your aortic aneurysm is and how large it is, you may be able to have a stent put in. If 

so, we will refer you to a surgeon. The procedure is called a thoracic endovascular aortic repair 

(TEVAR). It involves making a small cut in the groin and passing the stent into the aorta and 

putting it across the aneurysm. This approach is less invasive but it is not suitable for all 



For more information on the procedure, please ask the surgeon. 




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Complications of thoracic aortic aneurysms 


Aortic dissection 

This is when the weakened wall of the aorta tears, causing blood to leak between the layers that 

make up this wall. This can be ‘acute’ (happens suddenly) or ‘chronic’ (happens slowly over 

weeks/months). Unless this is treated, it may cause a reduced blood flow down the aorta and to 

important parts of the body. It can also lead to massive bleeding and can cause a rupture (see 




This is when all the layers of the aorta wall tear, causing blood to leak out from the aorta. This 

can stop blood being pumped round the body, so it is usually life-threatening and very few 

people survive it. 


Heart failure 

Heart failure is a condition caused by the heart failing to pump enough blood around the body at 

the right pressure. This can occur if the aneurysm gets large enough that it pulls the aortic valve 

open. This normally happens if the aneurysm is at the bottom of the aorta (the aortic root) or the 

ascending aorta. If the aortic valve doesn’t close after the blood is pumped through it, this 

allows the blood to flow backwards into the heart (called ‘aortic regurgitation’). This can increase 

the pressure in the left ventricle (one of the chambers of the heart). The heart can make up for 

his by working harder for a time, but eventually the heart cannot do this anymore and the 

umping ability of the heart is permanently affected.  




The care team 

If you have a TAA, a range of different health professionals will care for you. As well as the 

surgeon carrying out any procedure you have, you may also see radiologists, who will 

perform the CT scans and report the results and geneticists, who will be able to look at any 

inherited causes of aneurysms. Which health professionals you see will depend on exactly 

where your aneurysm is. 


Is there anything I can do to help myself? 

The thoracic aortic aneurysm will not get better, but there are certain things you can do to slow 

down its growth and prevent any further complications 


The most important step is to control your blood pressure. The British Heart Foundation 

recommends keeping your blood pressure below 140/90mmHg.. You can have your blood 

pressure recorded by the nurses at your GP practice, but we recommend that you buy or 

borrow a home blood pressure machine and take your blood pressure regularly. We suggest 

that you take your blood pressure  least three times a week, at varied times in the day and write 

down the result so you can let your GP or Consultant know when you see them.  Your GP can 

advise you further on ways of improving your blood pressure, or you may need to take 

medication to maintain your blood pressure at the recommended levels. 


We also advise you to keep your heart and aorta healthy. You can do this by:  

 stopping 


  reducing your cholesterol 

  maintaining good blood sugar levels if you are diabetic 

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  ensuring you are a healthy weight 

  having a healthy diet 

 exercising 



There are also things to avoid: 

  Don’t do any exercise that involves short bursts of activity, such as lifting excessive weight, 

as this can increase your blood pressure and put an increased strain on your aorta. A way to 

remember this is avoid anything that will make you grunt or groan. 

  Avoid being constipated, as the strain will increase your blood pressure. 


List of aortic surgeons 

Cardiac aortic surgeons 

Vinnie N Bapat 

Michael M Sabetai 

Christopher P Young 


Vascular/ aortic surgeons 

Rachel Bell 

Tomaso Dorati 

Bijan Modarai 

Morad Sallam 

Said Abisi 

Mark Tyrrell 

Michael Dialnas 





















Useful sources of information 

You may find our leaflet Having heart surgery useful. Please ask a member of the team for a 







Contact us 

If you have any questions or concerns, please contact the nurse case managers: 

t: 020 7188 1025 / 1085 / 7567 (9am–5pm Monday–Friday) 


For more information leaflets on conditions, procedures, treatments and services offered 

at our hospitals, please visit



Pharmacy Medicines Helpline 

If you have any questions or concerns about your medicines, please speak to the staff caring for 

you or call our helpline. 


 020 7188 8748 9am to 5pm, Monday to Friday 


Your comments and concerns 

For advice, support or to raise a concern, contact our Patient Advice and Liaison Service 

(PALS). To make a complaint, contact the complaints department. 


020 7188 8801 (PALS)   



020 7188 3514 (complaints) 



Language Support Services  

If you need an interpreter or information about your care in a different language or 

format, please get in touch: 


 020 7188 8815 



NHS 111 

Offers medical help and advice from fully trained advisers supported by experienced nurses 

and paramedics. Available over the phone 24 hours a day. 




NHS Choices  

Provides online information and guidance on all aspects of health and healthcare, to help 

you make choices about your health. 



Get involved and have your say: become a member of the Trust 

Members of Guy’s and St Thomas’ NHS Foundation Trust contribute to the organisation on a 

voluntary basis. We count on them for feedback, local knowledge and support. Membership is 

free and it is up to you how much you get involved. To find out more, and to become a member:  


 0800 731 0319 







Leaflet number: 4194/VER1

Date published: December 2015

Review date: December 2018

© 2015 Guy’s and St Thomas’ NHS Foundation Trust 

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