Treatments and drugsBy Mayo Clinic staff
The goal of treatment is to prevent your aneurysm from rupturing. Generally, your treatment options are medical monitoring or surgery. Your decision depends on the size of the aortic aneurysm and how fast it's growing.
If your thoracic aortic aneurysm is small, your doctor may recommend medical monitoring, which includes regular appointments to make sure your aneurysm isn't growing, and management of other medical conditions that could worsen your aneurysm.
It's likely your doctor will order regular imaging tests to check on the size of your aneurysm. Expect to have an echocardiogram at least six months after your aneurysm is diagnosed and regular exams and imaging tests after that.
If you have high blood pressure or blockages in your arteries, it's likely that your doctor will prescribe medications to lower your blood pressure and reduce your cholesterol levels to reduce the risk of complications from your aneurysm. These medications could include:
- Beta blockers. Beta blockers lower your blood pressure by slowing your heart rate. Examples of beta blockers include metoprolol (Lopressor, Toprol-XL), atenolol (Tenormin) and bisoprolol (Zebeta).
- Angiotensin II receptor blockers. Your doctor may also prescribe these medications if beta blockers aren't enough to control your blood pressure or if you can't take beta blockers. These medications are recommended for people who have Marfan syndrome, even if they don't have high blood pressure. Examples of angiotensin II receptor blockers include losartan (Cozaar), valsartan (Diovan) and olmesartan (Benicar).
- Statins. These medications can help lower your cholesterol, which can help reduce blockages in your arteries and reduce your risk of aneurysm complications. Examples of statins include atorvastatin (Lipitor), lovastatin (Mevacor), simvastatin (Zocor) and others.
Blood pressure should be less than 140/90 millimeters of mercury. The goal for cholesterol is to have low-density lipoprotein (LDL) cholesterol (the "bad" type of cholesterol) under 70 milligrams per deciliter.
If you smoke or chew tobacco, it's important that you quit. Using tobacco can worsen your aneurysm.
Surgery to prevent rupture
If you have a thoracic aortic aneurysm, surgery is generally recommended if your aneurysm is about 1.9 to 2.4 inches (5 to 6 centimeters) and larger. If you have Marfan syndrome, another connective tissue disease or a family history of aortic dissection, your doctor may recommend surgery for smaller aneurysms because you have a higher risk of having an aortic dissection.
Depending on your condition and the location of your thoracic aortic aneurysm, your doctor may recommend:
- Open chest surgery. Open chest surgery to repair a thoracic aortic aneurysm involves removing the damaged section of the aorta and replacing it with a synthetic tube (graft), which is sewn into place. This procedure requires open abdominal or open chest surgery, and it will take you a month or more to fully recover.
- Endovascular surgery. Doctors attach a synthetic graft to the end of a thin tube (catheter) that's inserted through an artery in your leg and threaded up into your aorta. The graft — a woven tube covered by a metal mesh support — is placed at the site of the aneurysm and fastened in place with small hooks or pins. The graft reinforces the weakened section of the aorta to prevent rupture of the aneurysm. Recovery time is generally faster with this procedure than with open surgery, but endovascular surgery can't be done on everyone. After endovascular surgery, you'll need to have regular follow-up imaging scans to ensure that the graft isn't leaking.
- Other heart surgeries. If another condition is contributing to your aneurysm's development, such as a problem with your heart's valves, your doctor may recommend additional surgeries to repair or replace the damaged valves to stop your aneurysm from worsening.
Although it's possible to repair a ruptured aortic aneurysm with emergency surgery, the risk is much higher and there is less chance of survival.
- Aneurysm. National Heart, Lung and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/arm/printall-index.html. Accessed Feb. 15, 2013.
- Hiratzka LF, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: Executive summary. Journal of the American College of Cardiology. 2010;55:27. http://circ.ahajournals.org/content/121/13/1544.full.pdf. Accessed Feb. 15, 2013.
- Aortic aneurysms. The Society of Thoracic Surgeons. http://www.sts.org/patient-information/aneurysm-surgery/aortic-aneurysms. Accessed Feb. 15, 2013.
- Aortic aneurysms. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merckmanuals.com/professional/print/cardiovascular_disorders/diseases_of_the_aorta_and_its_branches/aortic_aneurysms.html. Accessed Feb. 16, 2013.
- Papadakis MA, et al. Current Medical Diagnosis & Treatment 2013. 52nd ed. New York, N.Y.: The McGraw-Hill Companies; 2013. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=1. Accessed Feb. 16, 2013.
- Marfan syndrome. National Heart, Lung and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/mar/printall-index.html. Accessed Feb. 16, 2013.
- What is EDS? Ehlers-Danlos National Foundation. http://www.ednf.org/index.php?option=com_content&task=view&id=2202&Itemid=88889278. Accessed Feb. 16, 2013.
- Booher AM, et al. Diagnosis and management issues in thoracic aortic aneurysm. American Heart Journal. 2011;162:38.
- Jondeau G, et al. Genetics of thoracic aortic aneurysms. Current Atherosclerosis Report. 2012;14:219.
- Shah AA, et al. Results of thoracic endovascular aortic repair 6 years after United States Food and Drug Administration approval. Annals of Thoracic Surgery. 2012;94:1394.
- U.S. News best hospitals 2012-2013: Top-ranked hospitals for cardiology & heart surgery. http://health.usnews.com/best-hospitals/rankings/cardiology-and-heart-surgery. Accessed Feb. 16, 2013.
- Grogan M (expert opinion). Mayo Clinic, Rochester, Minn. Feb. 18, 2013.
- Bowen JM (expert opinion). Mayo Clinic, Rochester, Minn. Feb. 26, 2013.