Thoracic, Thoracoabdominal, and Iliac Artery Aneurysms




© Springer International Publishing Switzerland 2017
Tulio Pinho Navarro, Alan Dardik, Daniela Junqueira and Ligia Cisneros (eds.)Vascular Diseases for the Non-Specialist10.1007/978-3-319-46059-8_10


10. Thoracic, Thoracoabdominal, and Iliac Artery Aneurysms



Guilherme de Castro Santos , Raquel Ferreira Nogueira  and Carolina Ribeiro dos Santos 


(1)
Department of Surgery, Hospital das Clínicas Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 110. Santa Efigênia, Belo Horizonte, Minas Gerais, 30130-100, Brazil

(2)
Department of Surgery, Faculdade de Medicina da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 110, Belo Horizonte, Minas Gerais, 30130-100, Brazil

(3)
Hospital Risoleta Tolentino Neves, Rua Das Gabirobas, 1. Vila Cloris, Belo Horizonte, Minas Gerais, 31744-012, Brazil

 



 

Guilherme de Castro Santos (Corresponding author)



 

Raquel Ferreira Nogueira



 

Carolina Ribeiro dos Santos



Abstract

The estimated incidence of thoracic aortic aneurysms is approximately 6/100,000 person-years, the risk of rupture for large aneurysms is up to 74 % in patients without repair, and 90 % of patients do not survive rupture. Most of them are asymptomatic and the risk factors are the same related to abdominal aortic aneurysm. The majority of the patients are asymptomatic. They manifest themselves clinically with chest pain and can cause compressive symptoms when too large. The treatment approach for descending thoracic aortic aneurysms is based on the natural history of the disease, balancing the risk of rupture and the risk of the intervention and the patient’s life expectancy. Thoracic abdominal aortic aneurysms are those in which the aorta dilation encompasses the visceral vessels ostia. They are uncommon in clinical practice with prevalence estimated at between 10 to 25 new cases per 100,000 inhabitants. It is four times more common in men and has the same risk factors as abdominal aortic aneurysms. The decision to indicate intervention for a patient with a thoracic abdominal aneurysm involves assessment of the likelihood of aortic rupture versus the operative risk of the individual subject. The two major factors (the patient’s physiologic reserve and vascular anatomy) play a significant role in determining whether a patient is best suited for open repair or an endovascular approach.


Keywords
Thoracic aortic aneurysmsThoracoabdominal aortic aneurysmIliac artery aneurysmChest painShock


Thoracic, thoracoabdominal, and iliac artery aneurysms are most uncommon in comparison with the abdominal aortic aneurysms. High mortality rates are related with rupture, the most important complication.


Thoracic Aortic Aneurysm


The thoracic aortic aneurysms have an estimated incidence of approximately 6/100,000 person-years, the risk of rupture for large aneurysms is up to 74 % in patients without repair, and 90 % of patients do not survive rupture [1].

Most of them are asymptomatic, and the risk factors are the same related to abdominal aortic aneurysm. The majority of the patients are asymptomatic. They manifest themselves clinically with chest pain and can cause compressive symptoms when too large. There may be dyspnea, chest discomfort, and hoarseness in case of recurrent laryngeal nerve compression. Diagnosis is usually made through computerized angiotomography. There may be signs of mediastinum widening in chest x-ray. They have indication for surgical approach when larger than 6 cm in the descending aorta, when patients have characteristic pain and in every patient with symptoms or signs of rupture [2, 3].

The treatment approach for descending thoracic aortic aneurysms is based on the natural history of the disease, balancing the risk of rupture and the risk of the intervention and the patient’s life expectancy. Both open and endovascular repair of descending thoracic aneurysm have been shown to have multiple and severe complications. The early mortality varies to 5.7–9.7 % in open surgery and 1.9–2.0 % in endovascular surgery [1, 4, 5]. Endovascular surgery demonstrates midterm favorable outcomes and confirms low risks for patients with thoracic aortic aneurysm. The most common complication of endovascular surgery is the endoleaks that can be observed in 15 % of patients [6, 7].


Thoracoabdominal Aortic Aneurysm


Thoracic abdominal aortic aneurysms are those in which the aorta dilation encompasses the visceral vessels ostia. They are uncommon in clinical practice with prevalence estimated at between 10 to 25 new cases per 100,000 inhabitants. It is fourfold more common in men and has the same risk factors as abdominal aortic aneurysms. The most common type surrounds the entire abdominal aorta from the celiac artery and involves the aortic portion where to originate the visceral arteries [8]. Surgical treatment is technically complex and presents many particularities regarding access, exposure, the level of aortic clamping, reconstruction of visceral arteries and preserving vital organs function. It has high mortality when untreated, especially when larger than 5 cm, and rupture risk is greater than 50 % [9]. They have indication of surgical correction when larger than 5 cm in transverse diameter, in patients with signs and symptoms of rupture, in those with characteristic pain and those with growth rate greater than 6 mm in a year. In dedicated centers, mortality rates can vary from 3–21 %. Severe complications like renal failure, paraplegia, acute myocardial infarction, and stroke are frequently linked with this type of surgery. Endovascular repair of abdominal aortic aneurysms required a specific aortic anatomy, without dilatation in portions where the dispositive will be fixed. Complex aortic aneurysms require branched or fenestrated endoprothesis. The development of branched grafts opened the way to treat thoracoabdominal aneurysms endovascularly. Survival rates are above 90 %, with high spinal cord ischemia rates between 2.7 to 20 % [1012]. Although promising, the fenestrated and branched endografts still carry a significant rate of mortality and complications, mostly related to the complexity of the procedure [13].

Only gold members can continue reading. Log In or Register to continue

Sep 30, 2017 | Posted by in CARDIOLOGY | Comments Off on Thoracic, Thoracoabdominal, and Iliac Artery Aneurysms
Premium Wordpress Themes by UFO Themes