Thoracic Aortic Aneurysm-Procedures, Side effects, Recovery time, Costs and alternatives

This is a condition that causes a bulging in the upper part of the aorta, which lies in the thoracic region of the body. The thoracic region involves the area between the neck and abdomen. Aorta is the largest artery in humans, that transports blood from heart to the rest of the body. If the arterial walls of the aorta grow weaker, the walls will start expanding due to pressureof blood flowing through the aorta. With time, such an enlargement can grow bigger in size which will make the arterial walls even thinner and weaker. Eventually, the aorta can rupture or burst leading to excessive internal bleeding that may be fatal for patients.

There are different causes of thoracic aortic aneurysm, such as:

• Genetic disorders like Marfan syndrome, Ehlers
• Danlos syndrome, and Loeys
• Dietz syndrome. These are all disorders that affect the connective tissues in the body.
• Other pre
• existing cardiovascular diseases
• Injury in the chest region
• Atherosclerosis, a condition in which hardening of arteries occur due to formation of ‘plaque’ on the artery walls, is also known to cause thoracic aortic aneurysm.
• Smoking, hypertension and diabetes may not be a direct cause of this disease, but they are risk factors that can contribute to the occurrence of aneurysms.

This condition mostly affects patients above 50 years of age but it can occur in younger people as well. It is treatable if the aneurysm is diagnosed in an early stage, before it can burst or rupture.

There are two possible treatments for this condition – surgical process or endovascular treatment. Before proceeding to treatment, the doctor will first conduct a thorough diagnosis to locate the enlargement in the aorta, and then to measure its size. Tests that are mainly used during diagnosis of thoracic aortic aneurysm are X rays, computerized tomography (CT) scan, magnetic resonance imaging (MRI) and echocardiogram. If the aneurysm is detected and found to be small in size, the doctor will not suggest any immediate treatment, and will only observe and monitor the enlarged aorta regularly. But when a considerably large bulging is detected, urgent treatment will be required. As mentioned before, there are two options for the treatment and the doctor will choose the appropriate one as per the situation. Both treatment procedures are briefly described below.

1. Surgical Treatment
   This method involves conducting an open chest surgery on the patient under the influence of general anaesthesia. The steps involved in the surgery are:
   • General anaesthesia is administered to the patient before the operation.
   • Once surgery proceeds, the enlarged segment of the aorta is detected.
   • An incision is made in the chest, the size and exact location of the incision depends on the position of the bulged aorta.
   • The flow of blood is blocked in the aorta, and the enlarged portion of aorta is surgically removed using special tools and equipments.
   • An artificial graft is then sewn to the aorta to replace the bulged section.
   • The wounds and incisions are sealed.

After the surgery is completed, the patient will have to stay in the ICU for a few days and may have to stay further in a general ward even after being released from the ICU. It might take 7 to 10 days to be discharged after the surgery. The process of surgery is very complex and is performed by highly trained surgeons and professionals.

1. Endovascular aneurysm repair
   It’s a process in which a synthetic graft is placed in the enlarged aorta to prevent it from bursting. This is more of a non-invasive approach as compared to surgical treatment. The procedure is explained below.
   • A small incision is made, usually in the groin region. A catheter is inserted into the artery through the incision, and is taken all the way up to the widened segment of aorta with the help of special tools.
   • The tip of the catheter has an expanding stent graft attached to it, which is fixed inside the aorta at the site of aneurysm.
   • Then the catheter is removed, and the incision sealed.
   • After the process is complete, blood in the aorta starts flowing through the stent graft. As a result, the weak arterial walls at the enlarged section will become free from blood pressure, and bursting will be prevented. This process is also called Thoracic Endovascular Aortic Repair (TEVAR). Patients who have undergone endovascular treatment may need to stay in the hospital for a few days and are usually discharged within a week. However, not every person suffering from thoracic aortic aneurysm can be treated with this procedure, and this is determined by the doctor’s analysis.

All patients whohave developed an abnormally large aneurysm are eligible for treatment. A lot of people are diagnosed at a stage where the bulging has already grown big in size, because this condition hardly shows any symptoms in most people. Though in rare cases, people may experience some signs like chest or back pain, difficulty in swallowing and hoarseness. Many times, aneurysms are detected when a patient is undergoing diagnosis for some other condition. In any case, the treatment is available and suggested immediately to anyone affected by this condition with a sizeable enlargement that is at a risk of bursting.

People who are suffering from this disorder, but only have a small or moderately sized aneurysm are not eligible for treatment, because it is not required. Instead, such patients are kept under regular observation as they go on with their regular lives. The reason for this is because there is a chance that the aneurysm may not grow rapidly, thereby not posing any fatal threat. However, if excessive growth or any complication occurs during the observation period, then the doctor can suggest either surgical or endovascular treatment.

Since anaesthetics are used in both surgical and endovascular treatments, there is a chance that patients may experience some side-effects due to it, such as numbness, nausea or drowsiness. Other side effects that patients may experience are as follows:

A patient who has undergone any of the two treatment methods may be asked to follow the following instructions after surgery.

• Take painkillers and other prescribed medicines regularly.
• Keep the surgical incisions clean and sterile to avoid infection.
• Do not exert pressure on the body or indulge in physically exhausting activities until complete recovery.
• Get plenty of rest, and spend some time doing light exercises.
• Abstain from smoking and other harmful, addictive habits.
• Make sure to attend regular follow up sessions as per the doctor’s advice.

Patients usually spend 7 to 10 days in the hospital under doctor’s supervision after the open repair surgery.

Complete recovery will require 5 to 8 weeks if all conditions remain normal. But some patients may require up to 3 months or even more for full recovery due to other factors, such as minor complications after surgery or some existing disorders like heart problems, obesity or diabetes.

Endovascular treatment has a shorter recovery time than open chest surgery. Patients may have to spend 3 to 5 days in the hospital, and are expected to recover fully within a month.

Both surgical and endovascular treatment are complex procedures, and there isn’t much data publicly available regarding the cost of treatment. The price range will significantly vary depending on location and type of hospital. However, considering the complexity of the procedure and extra services required for hospital stay, it is best to be prepared for a minimum 3 to 5 lakhs. Doctors will discuss the overall expenses involved in the process with the patients before proceeding with treatment.

Both surgical and endovascular process provide permanent cure for patients in 90 to 95% of cases, and serve as an effective course of treatment for thoracic aortic aneurysm.

If thoracic aortic aneurysm is detected in patients, and the size of the bulging aorta is big enough to risk rupture, then surgery or endovascular repair is the only long-term treatment. Alternate course of treatment is exclusively for patients who have small sized aneurysm that doesn’t pose immediate threat. In those patients, medications are prescribed depending on the patient’s physiology and they are advised to maintain a healthy lifestyle with proper diet and exercise along with regular follow ups and imaging tests.