1.What is a thoracic aortic aneurysm? Thoracic aortic aneurysm is a permanent dilatation of the thoracic aorta with a diameter of more than twice the diameter of the normal thoracic aorta. Anatomically, it includes ascending aortic aneurysm, aortic arch aneurysm, and descending aortic thoracic segment aneurysm. 2.What are the causes of thoracic aortic aneurysm? Most of the causes of thoracic aortic aneurysms are atherosclerosis, followed by cystic necrosis of the middle layer of the artery, mucus degeneration, infection, trauma, congenital dysplasia and syphilis. 3.What is the danger of thoracic aortic aneurysm to human body? After the formation of thoracic aortic aneurysm, it often compresses the adjacent organs to produce symptoms such as chest and back pain, shortness of breath, difficulty in breathing and hoarseness. It may even corrode the skeletal tissues such as sternum, thoracic vertebrae and ribs, and expand to the body surface to become a pulsating mass. In the inflated part of the aneurysm, the blood flow slows down and forms vortex, which may also produce attached thrombus, which is easy to fall off and cause embolism of distal organs, and finally cause death due to severe compression of important organs or rupture of the aneurysm itself. 4.What kind of people have thoracic aortic aneurysm? The incidence of thoracic aortic aneurysm has similar characteristics to abdominal aortic aneurysm, such as it occurs mostly in the elderly, the incidence increases with age, and there are more men than women. It is reported that root and ascending aortic aneurysms account for 45% of thoracic aortic aneurysms, arch aortic aneurysms account for 10%, descending aortic aneurysms account for 35%, and thoracoabdominal aortic aneurysms account for 10%. 5. What kind of clinical manifestations should be thought of for thoracic aortic aneurysms? Thoracic aortic aneurysms are generally asymptomatic in the early stage, but symptoms appear as the aneurysm increases and compresses or obstructs the tissues and organs surrounding the aneurysm. Pain: Some patients with descending aortic aneurysm may experience pain, which is mostly dull in nature, usually persistent, and may increase with breathing, blood pressure, and activity, etc. Compression of intercostal nerves and thoracic spine may increase the pain. The pain is mostly in the back, but may also spread in all directions. Compression: compression of the trachea by thoracic aortic aneurysm may lead to cough, dyspnea and other symptoms, and in severe cases, may lead to pulmonary atelectasis, bronchitis and bronchiectasis; compression of the superior vena cava may lead to superior vena cava obstruction syndrome; compression of the recurrent laryngeal nerve may lead to hoarseness; compression of the esophagus may lead to dysphagia; when the aneurysm ruptures, esophageal or tracheal fistula may occur, which may lead to hemoptysis or vomiting of blood. 6.How to diagnose thoracic aortic aneurysm? A variety of special tests can be used to diagnose thoracic aortic aneurysms. For example, chest radiographs can show enlarged aortic bulb and widened mediastinum, but chest radiographs cannot be used as a means to confirm the diagnosis of thoracic aortic aneurysm. Enhanced CT is commonly used to diagnose thoracic aortic aneurysms. It has the characteristics of safety, simplicity, accuracy and economy. Therefore, enhanced CT is valuable in both the diagnosis and preoperative evaluation of thoracic aortic aneurysms. Spiral CT can also perform angiographic reconstruction to obtain CT angiographic (CTA) information. It can accurately measure the internal diameter and length of blood vessels. Magnetic resonance angiography (MRA) is also a good method for diagnosing thoracic aortic aneurysms, but MRA images are slightly blurred and are not as accurate, especially in measuring the internal diameter of the vessels. Transesophageal ultrasound (TEE) is a good method for diagnosing thoracic aortic aneurysms that is safe, noninvasive, sensitive and specific, and can make a very accurate and rapid diagnosis of thoracic aortic aneurysms. The disadvantage is that the operation cannot be successfully completed in patients with unstable conditions in the emergency department, and there are limitations in the observation of the arch and its branch vessels due to the interference of the trachea. Digital subtraction angiography (DSA) is an effective means of diagnosing thoracic aorta, but because it is an invasive and expensive test, DSA technology is more often used in the endoluminal treatment of thoracic aortic aneurysms. 7.What are the treatments for thoracic aortic aneurysm? The treatment methods for thoracic aortic aneurysm are traditional surgical treatment and endoluminal treatment. 8.Does a clear diagnosis of thoracic aortic aneurysm necessarily require surgery? Whether a thoracic aortic aneurysm requires surgery depends on whether the aneurysm has the possibility of rupture and whether there are symptoms. Generally, once a thoracic aortic aneurysm is diagnosed, if it is not treated, the risk of rupture will increase year by year as age increases, so regardless of the presence or absence of symptoms, once a thoracic aortic aneurysm is diagnosed, it should be carefully evaluated by a professional doctor. In cases where surgery is not contraindicated, treatment should be prompt. Patients should be operated more immediately when there is a sudden and rapid increase of the aneurysm, an increase of pain, or symptoms such as difficulty in breathing and swallowing due to the compression of the aneurysm. 9.What is the traditional surgical procedure for thoracic aortic aneurysm? The traditional surgical approach is to incise the thoracic cavity under general anesthesia, then remove the aneurysm and apply artificial blood vessels to reconstruct the defective aorta, which is suitable for most patients with thoracic aortic aneurysm. 10.Is traditional surgery for thoracic aortic aneurysm very invasive? The traditional surgical approach to thoracic aortic aneurysm is very traumatic, with a high rate of postoperative complications and high risk. Special complications include prolonged blockage of the thoracic aorta, which causes spinal cord injury due to ischemia, resulting in paraplegia. The greater the extent of the block and the longer the block, the higher the risk of paraplegia. Intraoperative massive blood loss, prolonged hypotension, prolonged deep hypothermic stopping circulation, prolonged intraoperative blocking of blood supply vessels to the brain, stenosis or occlusion of blood vessels after transplantation and embolization of blood clots or air during surgery can cause cerebral hypoxia and even lead to death of the patient in severe cases. 11.What is the principle of the endoluminal method for the treatment of thoracic aortic aneurysm? The principle of the endoluminal method for thoracic aortic aneurysm treatment is not to open the chest, not to remove the diseased vessel, but to make a small incision of 3-5cm in the groin and push the overlapping stent from the femoral artery through a delivery device to open the diseased area to isolate the aneurysm cavity and restore the normal blood flow state of the thoracic aorta so that the blood will not impact the dilated aneurysm wall and thus avoid aneurysm rupture. 12.What are the results of endoluminal treatment of thoracic aortic aneurysm? Endoluminal technology has been widely used in the treatment of thoracic descending aortic aneurysms, and with the innovation of technology and products, the treatment results have gradually improved. The endoluminal treatment technique is less invasive, with rapid postoperative recovery and low complication rates. The perioperative mortality rate is <5%, the incidence of paraplegia is about 3%, the incidence of endoleaks is about 10%, and the 5-year survival rate is >80%. 13.What do patients need to pay attention to in their life after thoracic aortic aneurysm surgery? (1) Control blood pressure and heart rate: Take oral antihypertensive drugs regularly as prescribed by the doctor to control blood pressure within the normal range (systolic blood pressure not higher than 140 mmHg, diastolic blood pressure not higher than 90 mmHg), especially to avoid blood pressure fluctuations. The heart rate should be controlled within 80 beats per minute. (2) Improve lifestyle, moderate exercise, avoid strenuous exercise, low-salt, low-fat and light diet, avoid emotional excitement, and actively control blood lipids and blood sugar. (3) Regular vascular ultrasound or CTA review should be performed at 3 months, 6 months, 9 months and 1 year after surgery.