Thoracic Aortic Aneurysms TAA

Good morning everyone! Welcome back to another day of #AorticDiseaseAwarenessMonth! Yesterday we gave a brief overview of the structure and function of the Aorta. Here's a trivia challenge - Which layer of the aorta (intima, media, adventitia) provides the greatest strength? Comment your answers below - no peaking ;)

Today we will be discussing a TAAs or thoracic aortic aneurysms.

https://www.mayoclinic.org/diseases-conditions/thoracic-aortic-aneurysm/symptoms-causes/syc-20350188#dialogId28168701

Overview

An aneurysm refers to a bulging, "ballooned" area within the wall of a blood vessel causing it to dilate and stretch to a size larger than its normal width. The major concern when an aneurysm occurs is that the vessel loses a lot of its natural strength and ability to accommodate different blood volumes and may rupture due to instability.

Aneurysms of the brain and heart vessels carry a major risk and require careful screening, long-term monitoring and care by doctors.

TAA

Thoracic aortic aneurysms refer to any aneurysm that include the thoracic component of the aorta, including the ascending aorta, arch or upper part of the descending aorta up to the diaphragm muscle. Be sure to refer to yesterday's post where we went over the different regions of the aorta!

https://sites.uw.edu/uwmtap/thoracic-aneurysm-dissection/

Causes

The easiest way to understand causes of TAA is to remember that aneurysms are "weak" parts within the aortic wall. This means that they develop when our poor aorta is subjected to increased strain or pressure for extended periods of time.

The most common cause of TAA is atherosclerosis, which refers to the accumulation of fat and calcium deposits within the innermost lining or tunica intima layer. This can cause damage to those beautiful endothelial cells and stop the smooth transfer of nutrients and oxygen in our blood.

They are also strongly associated with connective tissue disorders, such as Marfan Syndrome, Ehler-Danlos, and Loeys-Dietz syndrome. Patients with Turner Syndrome are also strongly associated with TAA (especially of the aortic root).

Other risk factors include high blood pressure (increased strain of blood flow as it travels through the walls) , smoking (which directly damages endothelial cells).

Symptoms

Most TAAs do not produce notable symptoms until they become large enough to compress nearby structures or rupture.

When symptom do occur they could include things such as pain in chest and back, difficulty swallowing (dysphagia) or shortness of breath. Some people may also feel a "beating" mass in their chest which can be described as "pulsating".

Rupture of a TAA is a medical emergency and will present with a sudden, sharp pain in the upper back that travels to the back and downwards, sudden drop in blood pressure and dizziness / loss of consciousness.

Diagnosis, Management and Treatment

To diagnose a TAA, your doctor will order a series of imaging studies to be able to directly visualize the entire aorta and identify aneurysms.

Such studies may include things such as an ultrasound, CT scans, MRI and/or angiography to determine their size and location. Duc will be discussing all of these tests more in depth later this month!

https://en.wikipedia.org/wiki/Thoracic_aortic_aneurysm#/media/File:CTRupturedTA.PNG

Treatment of TAAs will vary depending on how big they are, where they are located, and a review of a patient's other health conditions. While small aneurysms can be monitored with routine images and management of a patient risk factors, such as blood pressure, large aneurysms can be repaired using open surgery or endovascular procedures to prevent rupture.

Some lifestyle adjustments one can make to decrease their risk of a TAA including managing their blood pressure and lipid levels, maintaining a health active lifestyle and quitting smoking. If you are at high-risk for TAAs or have a family history for one, be sure to always discuss your concerns and potential screening options.

And that wraps up this today's session!

Be sure to check out some of these links for more information about TAAs:

• https://my.clevelandclinic.org/health/diseases/17552-aorta-thoracic-aortic-aneurysm

• https://www.hopkinsmedicine.org/health/conditions-and-diseases/thoracic-aortic-aneurysm

• https://www.mayoclinic.org/diseases-conditions/thoracic-aortic-aneurysm/symptoms-causes/syc-20350188#:~:text=Causes%20of%20thoracic%20aortic%20aneurysms,arteries%20to%20weaken%20and%20widen.
  

Join us back here tomorrow where Duc will be discussing abdominal abdominal aneurysms (AAA). Thanks for tuning in and as always, remember to #ThinkAorta!

Until next time,

Adham