The goal of treatment is to prevent your aneurysm from rupturing. Generally, your treatment options are medical monitoring or surgery. Your doctor's decision depends on the size of the aortic aneurysm and how fast it's growing.
If your thoracic aortic aneurysm is small, your doctor may recommend medical monitoring, which includes regular appointments to make sure your aneurysm isn't growing, and management of other medical conditions that could worsen your aneurysm. Your doctor will also ask you about any signs or symptoms you may be experiencing that could be related to the aneurysm.
It's likely your doctor will order regular imaging tests to check on the size of your aneurysm. Expect to have an echocardiogram, CT scan or magnetic resonance angiography (MRA) at least six months after your aneurysm is diagnosed, and at regular follow-up exams and imaging tests after the first imaging test. The frequency of your imaging tests depends on whether the aneurysm is growing, and how fast it's growing.
If you have high blood pressure or blockages in your arteries, it's likely that your doctor will prescribe medications to lower your blood pressure and reduce your cholesterol levels to reduce the risk of complications from your aneurysm. These medications could include:
- Beta blockers. Beta blockers lower your blood pressure by slowing your heart rate. For people with Marfan syndrome, beta blockers may reduce how fast the aorta is dilating. Examples of beta blockers include metoprolol (Lopressor, Toprol-XL), atenolol (Tenormin) and bisoprolol (Zebeta).
- Angiotensin II receptor blockers. Your doctor may also prescribe these medications if beta blockers aren't enough to control your blood pressure or if you can't take beta blockers. These medications are recommended for people who have Marfan syndrome, even if they don't have high blood pressure. Examples of angiotensin II receptor blockers include losartan (Cozaar, Hyzaar), valsartan (Diovan) and olmesartan (Benicar).
- Statins. These medications can help lower your cholesterol, which can help reduce blockages in your arteries and reduce your risk of aneurysm complications. Examples of statins include atorvastatin (Lipitor), lovastatin (Altoprev), simvastatin (Zocor) and others.
The blood pressure goal is less than 140/90 millimeters of mercury.
If you smoke or chew tobacco, it's important that you quit. Using tobacco can worsen your aneurysm.
Surgery to prevent rupture
If you have a thoracic aortic aneurysm, surgery is generally recommended if your aneurysm is about 1.9 to 2.4 inches (about 5 to 6 centimeters) and larger. If you have Marfan syndrome, another connective tissue disease, a bicuspid aortic valve or a family history of aortic dissection, your doctor may recommend surgery for smaller aneurysms because you have a higher risk of having an aortic dissection.
Most people with a thoracic aortic aneurysm have open chest surgery, but in some select cases your doctor may determine you're a candidate for endovascular surgery. Depending on your condition and the location of your thoracic aortic aneurysm, your doctor may recommend:
Open chest surgery. Open chest surgery to repair a thoracic aortic aneurysm involves removing the damaged section of the aorta and replacing it with a synthetic tube (graft), which is sewn into place. This procedure requires open abdominal or open chest surgery, and it will take you a month or more to fully recover.
If you have Marfan syndrome or other related conditions, you may have surgery to treat a section of the aorta that lies close to the junction of the aorta and the heart (aortic root). In aortic root replacement, your surgeon removes a section of your aorta and your aortic valve and replaces the section of the aorta with an artificial tube (graft). The aortic valve is replaced with a mechanical or biological valve.
Alternatively, you may have valve-sparing aortic root repair, in which your surgeon replaces the enlarged section of the aorta with a graft, and the aortic valve remains in place.
Endovascular surgery. Doctors attach a synthetic graft to the end of a thin tube (catheter) that's inserted through an artery in your leg and threaded up into your aorta. The graft — a woven tube covered by a metal mesh support — is placed at the site of the aneurysm and fastened in place with small hooks or pins. The graft reinforces the weakened section of the aorta to prevent rupture of the aneurysm.
Recovery time is generally faster with this procedure than with open chest surgery, but endovascular surgery can't be done on everyone. Discuss with your doctor whether you're a candidate for this procedure. After endovascular surgery, you'll need to have regular follow-up imaging scans to ensure that the graft isn't leaking.
- Other heart surgeries. If another condition is contributing to your aneurysm's development, such as a problem with your heart's valves, your doctor may recommend additional surgeries to repair or replace the damaged valves to stop your aneurysm from worsening.
After surgery, your doctor may recommend regular monitoring of your condition.
Although it's possible to repair a ruptured aortic aneurysm with emergency surgery, the risk is much higher and there is a higher chance of complications. Because of this, doctors prefer to identify and treat thoracic aortic aneurysms before they rupture, and to follow through with lifelong monitoring and appropriate preventive surgery.
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