Thoracic Aortic Aneurysm Treatment Program: Prevention

Prevention of thoracic aortic aneurysm.

Thoracic aortic aneurysm (TAA) is a complication of degeneration of the wall integrity of the aorta from conditions that are risk factors for atherosclerosis. Other causes include aortitis as part of a systemic autoimmune disease and inherited connective tissue disease.

When TAA is present, risk of rupture rises as TAA expansion increases.

Prevention of TAA due to Atherosclerosis

• Management/treatment of atherosclerosis and hypertension via smoking cessation, weight control, exercise, and when necessary, antihypertensive and/or statin medication
• Rule out co-existing aneurysms elsewhere via imaging
• Genetic testing for inherited aortic disease in those with a strong family history of aneurysm

Prevention of TAA due to Aortitis

• Aggressively treat bacteremia, sepsis, or septic embolization 
• Manage autoimmune disorders such as giant cell arteritis, Takayasu arteritis, rheumatoid arthritis, ankylosing spondylitis, Wegener’s granulomatosis, reactive arthritis, and Behcet syndrome
• Genetic testing for inherited aortic disease in those with a strong family history of aneurysm 

Prevention of TAA due to Connective Tissue Disease

In disorders such as Marfan syndrome, vascular Ehlers Danlos syndrome, Loeys-Dietz syndrome, and Turner syndrome, prevention of the actual aneurysm may be possible only by eliminating other risk factors, such as hypertension. When TAA is already present, prevention centers on expansion and dissection.

Prevention of TAA Dissection and Rupture

• Elective (pre-emptive) repair of a TAA after diameter expands >5.5 cm, due to increased incidence of rupture beyond 6 cm. Those with connective tissue etiologies or with rapidly expanding TAA should be repaired earlier 
• Identify other co-existent aneurysms via aggressive surveillance with imaging