What is a thoracic aortic aneurysm? A thoracic aortic aneurysm is a permanent dilatation of the thoracic aorta that reaches more than twice the diameter of the normal thoracic aorta. Anatomically, this includes ascending aortic aneurysms, aortic arch aneurysms, and descending aortic thoracic segment aneurysms. What are the causes of thoracic aortic aneurysms? The majority of thoracic aortic aneurysms are caused by atherosclerosis, followed by cystic necrosis of the middle layer of the artery, mucus degeneration, infection, trauma, congenital dysplasia and syphilis. What are the risks 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 erode the skeletal tissues such as the sternum, thoracic vertebrae and ribs, and expand toward the body surface to become a pulsating mass. In the inflated aneurysm, blood flow slows down and vortex is formed, which may also produce attached thrombus, and the thrombus can easily dislodge and cause embolism of distal organs, and eventually lead to death due to severe compression of important organs by the aneurysm or rupture on its own. What kind of people are prone to thoracic aortic aneurysm? Thoracic aortic aneurysms have similar characteristics to abdominal aortic aneurysms, such as occurring more often in the elderly, increasing in incidence with age, and being more common in men than women. It has been reported that 45% of thoracic aortic aneurysms are root and ascending aortic aneurysms, 10% are arch aortic aneurysms, 35% are descending aortic aneurysms, and 10% are thoracoabdominal aortic aneurysms What kind of clinical manifestations should be thought of as thoracic aortic aneurysms? Thoracic aortic aneurysms are generally asymptomatic in the early stages, but symptoms appear as the aneurysm grows and compresses or obstructs the tissues and organs surrounding the aneurysm. Pain: Some patients with descending aortic aneurysm will have pain symptoms, mostly dull pain in nature, which is usually persistent and may intensify with breathing, blood pressure and activity, etc. Compression of intercostal nerve and thoracic spine will intensify the pain. The pain is mostly in the back, but may also spread around. 2.Compression: compression of the trachea by thoracic aortic aneurysm may lead to coughing and dyspnea, 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. How is a thoracic aortic aneurysm diagnosed? A variety of special tests can be used to diagnose thoracic aortic aneurysms. For example, an enlarged aortic bulb and widened mediastinum can be seen on a chest radiograph, but a chest radiograph cannot be used 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 diagnose thoracic aortic aneurysms very accurately and quickly. 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 tool for diagnosing thoracic aortas, but because it is an invasive and expensive test, DSA techniques are more often used in the endoluminal treatment of thoracic aortic aneurysms. What are the treatment options for thoracic aortic aneurysms? The treatment of thoracic aortic aneurysms is both traditional surgical treatment and endoluminal treatment. Does a definite diagnosis of thoracic aortic aneurysm necessarily require surgery? The need for surgery for thoracic aortic aneurysms depends on the likelihood of rupture and the presence of symptoms. Generally, once a thoracic aortic aneurysm is diagnosed, if left untreated, the risk of rupture will increase year by year with increasing age. In cases where surgery is not contraindicated, treatment should be prompt. Patients with sudden and rapid enlargement of the aneurysm, increased pain, or difficulty in breathing or swallowing due to the compression of the aneurysm should be operated more immediately. 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 an artificial vessel to reconstruct the defective aorta, which is suitable for most patients with thoracic aortic aneurysm. Is traditional surgery for thoracic aortic aneurysm very invasive? The traditional surgical approach to thoracic aortic aneurysms is very invasive and has a high rate of postoperative complications and risks. Specific complications include prolonged blockade of the thoracic aorta and spinal cord injury due to ischemia, which can lead to 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 patient death in severe cases. What is the principle of the endoluminal approach to treat thoracic aortic aneurysm? The principle of the endoluminal approach to thoracic aortic aneurysm treatment is not to open the chest, not to remove the diseased vessel, but to make a small incision of 3-5 cm in the groin, and to push the overlapping stent from the femoral artery through a delivery device to the diseased area to open it and isolate the aneurysm cavity to restore the normal blood flow of the thoracic aorta, so that the blood will not impact the dilated aneurysm wall and thus avoid aneurysm rupture. What are the results of endoluminal treatment of thoracic aortic aneurysms? Endoluminal techniques have been widely used in the treatment of thoracic descending aortic aneurysms, and outcomes have gradually improved with innovations in technology and products. 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%. 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. Heart rate should be controlled within 80 beats/min. 2.Improve lifestyle, moderate exercise, avoid strenuous exercise, low salt and low fat light diet, avoid emotional excitement, and actively control blood lipid 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.