Materiały źródłowe

• #1 Thoracic aortic aneurysm: Optimal surveillance and treatment | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/87/9/557

  Aneurysm of the thoracic aorta is less common than in the abdominal aorta, but it is clinically important because of the risk of rupture and death. […] There are no effective preventive strategies for TAA to date; thus, early detection, surveillance, and treatment are critical to improving outcomes. Guidelines are available. […] The need for prophylactic intervention is based on aneurysm size, location, growth, and other associated conditions and risk factors in the individual patient. Management strategies include surgery, which is mandatory in the acute setting and in cases of challenging anatomy, and endovascular techniques. Regular imaging surveillance is critical after diagnosis and after aneurysm interventions. […] Patients with thoracic aortic aneurysm require multidisciplinary care, including a cardiologist and possibly a cardiovascular surgeon and genetic counselor. […] Medical care includes traditional cardiovascular risk factor management. Beta-blockers are often used to control blood pressure but should be used with caution in those with acute aortic valve regurgitation.

• #1 Thoracic Aortic Aneurysm – UChicago Medicine

  https://www.uchicagomedicine.org/conditions-services/heart-vascular/aortic-disease/thoracic-aortic-aneurysm

  Knowing if you have certain risk factors that predispose you to thoracic aortic aneurysm can be the best prevention against this fatal condition. […] Leading a healthy, or healthier, lifestyle can dramatically reduce your risk of aortic aneurysm. Having regular exams to monitoring your cholesterol and blood pressure can lower your chances of having a severe an aortic aneurysm. […] For those who smoke, making the effort to stop smoking is critical for long-term aneurysm prevention.

• #1 Treatment of thoracic aortic aneurysm

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5879515/

  Persons with thoracic AA must be counseled about smoking cessation and referred to a smoking cessation program with either use of nicotine replacement, varenicline, or bupropion (3). […] Current cigarette smoking is a major risk factor for development of thoracic AA. Dyslipidemia must be treated. Atorvastatin 40 to 80 mg daily or rosuvastatin 20 to 40 mg daily should be administered to persons with thoracic AA (4). […] Hypertension must be controlled to decrease myocardial infarction, stroke, heart failure, death from cardiovascular causes, and aortic dissection (3,7-12). The blood pressure in persons with thoracic AA should be lowered to less than 130/80 mmHg. A beta blocker plus an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker should be administered to these persons (3,7).

• #1 Thoracic Aortic Aneurysm: Care Instructions | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.thoracic-aortic-aneurysm-care-instructions.zc1809

  Manage blood pressure. A healthy lifestyle along with medicines may help you lower your blood pressure. […] Manage cholesterol to help keep your blood vessels healthy. A healthy lifestyle along with medicines may help you manage cholesterol. […] Do not smoke. Smoking can make the aneurysm grow faster. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good. […] Stay at a healthy weight. Lose weight if you need to. […] Eat heart-healthy foods. These include fruits, vegetables, whole grains, fish, and low-fat or nonfat dairy foods. Limit sodium, alcohol, and sweets. […] Ask your doctor what type and level of activity is safe for you. If your doctor recommends it, get regular exercise. Walking is a good choice. Bit by bit, increase the amount you walk every day. Try for at least 30 minutes on most days of the week. You also may want to swim, bike, or do other activities. […] Manage other health problems. If you think you may have a problem with alcohol or drug use, talk to your doctor.

• #1 10 Tips to Help Reduce Your Risk of an Aortic Aneurysm This Valentine’s Day | Bangkok Heart Hospital

  https://www.bangkokhearthospital.com/en/content/10-tips-to-help-reduce-your-risk-of-an-aortic-aneurysm-this-valentines-day

  Have a regular check-up or screening test if you are in a high risk group. It is recommended that an ultrasound screening or CT-scan should be performed in high risk group as below. […] Early detection can prevent premature death from a ruptured aortic aneurysm. Quit smoking. Smoking cessation reduces the risk of ruptured aortic aneurysm by 4 times. Eat a heart healthy diet. A heart-healthy diet includes fruits, vegetables, high-fiber foods, and foods low in saturated fat and cholesterol. […] Avoid alcohol. Alcohol drinking leads to hypertension and increase the risk of aortic aneurysm.

• #1 Thoracic Aortic Diseases | University of Ottawa Heart Institute

  https://www.ottawaheart.ca/heart-condition/thoracic-aortic-diseases

  Heart healthy diet with low fat and salt will prevent the build-up of plaque in the aorta and other arteries. Low salt (sodium) will help to lower blood pressure. […] Stress contributes to high blood pressure. Management of stress through exercise, yoga, mindfulness activities (meditation) and counselling are recommended. The Heart Institute offers stress management courses. […] Medical treatment involves regular imaging of the aorta and careful management of blood pressure to achieve a measurement 130/80 mmHg. Advice on appropriate exercise, diet, smoking cessation, and stress management are also provided.

• #1 Thoracic Aortic Aneurysm | University of Michigan Health

  https://www.uofmhealth.org/conditions-treatments/thoracic-aortic-aneurysm

  Treatment options for ascending, arch, descending and root aortic aneurysms may include: […] Regular screenings to monitor the size and growth of the aneurysm to determine if treatment including surgery is necessary […] Lifestyle changes such as smoking cessation, controlling diabetes and a low-fat diet to reduce cholesterol levels. These changes may help keep the aneurysm from growing. […] Medication to help reduce high blood pressure and cholesterol levels.

• #1 Thoracic aortic aneurysm – Symptoms and causes – Mayo Clinic

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

  To prevent an aneurysm, keep the blood vessels as healthy as possible. Try these healthy lifestyle tips. […] Don’t smoke or use tobacco. […] Control blood pressure and cholesterol levels. […] Keep a healthy weight and stay active. […] Eat nutritious foods. […] Screening means that you have regular imaging tests, usually an echocardiogram, to look for an aneurysm. […] Your healthcare professional may suggest screening for a thoracic aneurysm if: […] You have a parent, brother, sister, son or daughter with a genetic condition linked to thoracic aortic aneurysms. An example is Marfan syndrome. […] You have a family history of aortic aneurysms and wish to get pregnant. […] If a screening test shows a larger than usual aorta or an aneurysm, the test is usually repeated within 6 to 12 months to look for changes.

• #1 Thoracic aortic aneurysm – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/thoracic-aortic-aneurysm/diagnosis-treatment/drc-20350193

  The goals of treatment for a thoracic aortic aneurysm are to: […] Stop the aneurysm from growing. […] Prevent aortic rupture. […] Treatment depends on the aneurysm’s size and how fast it’s growing. […] Small thoracic aneurysms may only need medicine and regular imaging tests to watch the aneurysm. […] Usually you get an echocardiogram, CT or magnetic resonance angiography scan at least six months after your aneurysm is diagnosed. […] Healthy lifestyle changes can help protect the heart and blood vessels. It’s never too early to start. Eat healthy foods, stay active and do not smoke. Taking these steps can help prevent thoracic aortic aneurysm and its complications. […] If you’re diagnosed with a thoracic aortic aneurysm, ask how often you need health checkups.

• #1 Thoracic Aortic Aneurysms – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/diseases-of-the-aorta-and-its-branches/thoracic-aortic-aneurysms

  Most thoracic aortic aneurysms result from atherosclerosis. […] Risk factors for both thoracic aortic aneurysms and aortic dissections include prolonged hypertension, dyslipidemia, and smoking. Additional risk factors for TAAs include presence of aneurysms elsewhere in the body, infection, aortitis, and older age (peak incidence at age 65 to 70 years). […] Immediate control of hypertension is essential. Medical management with optimal control of hypertension, dyslipidemia, diabetes, and respiratory disease is the appropriate treatment until surgery is indicated. […] Asymptomatic aneurysms that do not meet criteria for elective surgical or endovascular repair are treated with aggressive blood pressure control using a beta-blocker and other antihypertensives if necessary. Smoking cessation is essential. Dyslipidemia, diabetes, and respiratory diseases should all be treated. […] Patients require frequent follow-ups to check for symptoms and serial CT or ultrasound every 6 to 12 months. Imaging frequency depends on aneurysm size.

• #1 Management of thoracic aortic aneurysm in adults – UpToDate

  https://www.uptodate.com/contents/management-of-thoracic-aortic-aneurysm-in-adults

  Management of thoracic aortic aneurysm in adults […] Conservative management of asymptomatic TAA aims to lessen stress on the aorta and limit further aortic expansion. Asymptomatic patients who do not meet the criteria for repair also require ongoing aneurysm surveillance. […] For patients who meet the criteria for repair, survival is improved for open surgery compared with medical therapy alone. This should also be the case for endovascular repair, given that endovascular repair compares favorably with open surgery. Asymptomatic patients with TAA who do not meet the criteria for repair are managed medically with routine surveillance.

• #1 Prophylactic Surgery for Thoracic Aortic Aneurysm

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10106997/

  A 68-year-old man presented for evaluation of a 5.0-cm asymptomatic ascending aortic aneurysm. […] Given the possibility that his TAD might be heritable, the patient was advised to have his first-degree relatives screened with TTE or CTA to examine both the aortic root and ascending aorta. […] The typical threshold for prophylactic surgical replacement in cases of heritable TAD is an aortic diameter of 5.0 cm, as opposed to 5.5 cm for sporadic TAD. […] The optimal timing of prophylactic surgery to prevent potential aortic dissection or rupture depends heavily on the genetic context in which the aneurysm occurs, as heritable aneurysms tend to grow faster and dissect earlier. […] Because of the increased likelihood of these events among patients with HTAD compared to those with non-HTAD, they should be referred for prophylactic surgery at a maximal aortic diameter 5.0 cm.

• #1 Thoracic Aortic Aneurysms: At What Size Should We Intervene? – Endovascular Today

  https://evtoday.com/articles/2017-nov/thoracic-aortic-aneurysms-at-what-size-should-we-intervene

  Symptomatic aneurysms and aneurysms associated with a rapid growth rate of 1 cm per year should also be repaired because of an increased risk for rupture. […] Current guidelines for repair suggest the threshold for prophylactic surgical aortic repair to be within the range of 5.5 to 6 cm, but the decision regarding which individual will benefit from repair remains challenging. […] At present, it seems that there is no one-size-fits-all treatment, and therefore, patient selection should be performed on an individual basis according to morphological complexities, comorbidities, and anticipated overall survival and durability of any repair.

• #1 Current approaches to spinal cord protection during open thoracoabdominal aortic aneurysm repair – Coselli- Annals of Cardiothoracic Surgery

  https://www.annalscts.com/article/view/17014/html

  Spinal cord deficit (SCD) is a feared complication after thoracoabdominal aortic aneurysm repair. Vigilant management throughout the perioperative period is necessary to reduce the risk of SCD. Measures for preventing SCD during the intraoperative period include preoperative optimization and recognizing patients at a higher risk of SCD. […] If SCD is recognized early, therapeutic intervention may be implemented to mitigate injury. […] CSFD is a vital component of spinal cord protection that works by lowering intrathecal CSF pressure. Our group has shown in a randomized trial that the use of CSFD in extent I and II TAAA repairs resulted in an 80% relative risk reduction in the development of SCD. […] Currently, our CSFD use rates are as follows: extent I, 97%; extent II, 98%; extent III, 77%; extent IV, 36%.

• #1 Integrated Aortic Program | Thoracic Aneurysm Program

  https://www.valleyhealth.com/services/integrated-aortic-program

  Living with an aortic aneurysm can be stressful, but when managed properly, patients can enjoy an excellent quality of life. […] Our cardiology department embraces a holistic approach focused on and tailored to each patient, and the team is committed to high-quality care and patient safety, using leading-edge research to offer patients the latest treatments and clinical advice. […] If a patient is diagnosed with an aortic aneurism, it is important for them to notify family to potentially be screened for an aortic aneurysm as well. The First-Degree Relative program provides screening, imaging and long-term surveillance for those individuals who have a relative diagnosed with a thoracic aneurysm. […] Every patient in the Integrated Aortic Program receives an individualized treatment plan that includes managing risk factors such as high blood pressure and high cholesterol. Patients also receive personalized education on safe activities and lifting with an aneurysm. For most patients, regular surveillance combined with risk factor management is enough treatment to safely manage their aneurysm.

• #1 Thoracic Aortic Aneurysm & Aortic Dissection | Marfan Foundation

  https://marfan.org/conditions/familial-aortic-aneurysm/

  Medications (drugs) that reduce the stress on the aorta can be helpful. Beta-blockers help lower blood pressure and reduce the force of the heartbeat. They also may help prevent or slow aortic enlargement and reduce the risk of aortic dissection. […] People with familial thoracic aortic aneurysm and dissection must have routine tests to monitor their aortic health and identify problems before there is an emergency. These are the same imaging tests that doctors use to diagnose the condition: echocardiogram, MRI, CT scan, or TEE. […] Surgery is most effective if it is done before an aortic dissection or other life-threatening situation. Surgery is considered when: The rate of enlargement of the ascending aorta approaches 0.5 cm per year; The diameter of the ascending aorta is between 4.2 and 5.0 cm (depending on the underlying mutation or family history). […] Regardless of which type of surgery is performed, patients must continue to take their blood pressure medicine and have their aorta monitored at least once a year to safeguard against additional enlargements or tears in other parts of the aorta.

• #1 Largest-ever study of thoracic aortic aneurysm supports treatment guidelines – Kaiser Permanente Division of Research

  https://divisionofresearch.kaiserpermanente.org/taa-study-supports-guidelines/

  A diagnosis of a thoracic aortic aneurysm a bulge in the part of the main artery that runs through the chest can be frightening. […] But a large, new Kaiser Permanente study provides high-quality evidence that most of the 33,000 patients diagnosed each year in the U.S. with a thoracic aortic aneurysm are not likely to experience a tear or rupture an aortic dissection and may not need open-heart surgery. […] The study, published October 5 in JAMA Cardiology, is the largest to date to support the current consensus guidelines that recommend surgery for most patients with a thoracic aneurysm that is 5.5 centimeters or larger. […] Our study shows that regular monitoring, coupled with aggressive blood pressure control and lifestyle changes, is a safe strategy for most patients until the aneurysm reaches the 5.5 centimeter mark, when surgery becomes necessary, said Solomon, who is the founder and director of the KPNC Center for Thoracic Aortic Disease. […] Patients absolutely need this surgery when surgical risk is less than the risk of dissection.

• #2 Thoracic aortic aneurysm – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/thoracic-aortic-aneurysm/diagnosis-treatment/drc-20350193

  The goals of treatment for a thoracic aortic aneurysm are to: […] Stop the aneurysm from growing. […] Prevent aortic rupture. […] Treatment depends on the aneurysm’s size and how fast it’s growing. […] Small thoracic aneurysms may only need medicine and regular imaging tests to watch the aneurysm. […] Usually you get an echocardiogram, CT or magnetic resonance angiography scan at least six months after your aneurysm is diagnosed. […] Healthy lifestyle changes can help protect the heart and blood vessels. It’s never too early to start. Eat healthy foods, stay active and do not smoke. Taking these steps can help prevent thoracic aortic aneurysm and its complications. […] If you’re diagnosed with a thoracic aortic aneurysm, ask how often you need health checkups.

• #2 Thoracic aortic aneurysm – Symptoms and causes – Mayo Clinic

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

  To prevent an aneurysm, keep the blood vessels as healthy as possible. Try these healthy lifestyle tips. […] Don’t smoke or use tobacco. […] Control blood pressure and cholesterol levels. […] Keep a healthy weight and stay active. […] Eat nutritious foods. […] Screening means that you have regular imaging tests, usually an echocardiogram, to look for an aneurysm. […] Your healthcare professional may suggest screening for a thoracic aneurysm if: […] You have a parent, brother, sister, son or daughter with a genetic condition linked to thoracic aortic aneurysms. An example is Marfan syndrome. […] You have a family history of aortic aneurysms and wish to get pregnant. […] If a screening test shows a larger than usual aorta or an aneurysm, the test is usually repeated within 6 to 12 months to look for changes.

• #2 10 Tips to Help Reduce Your Risk of an Aortic Aneurysm This Valentine’s Day | Bangkok Heart Hospital

  https://www.bangkokhearthospital.com/en/content/10-tips-to-help-reduce-your-risk-of-an-aortic-aneurysm-this-valentines-day

  Have a regular check-up or screening test if you are in a high risk group. It is recommended that an ultrasound screening or CT-scan should be performed in high risk group as below. […] Early detection can prevent premature death from a ruptured aortic aneurysm. Quit smoking. Smoking cessation reduces the risk of ruptured aortic aneurysm by 4 times. Eat a heart healthy diet. A heart-healthy diet includes fruits, vegetables, high-fiber foods, and foods low in saturated fat and cholesterol. […] Avoid alcohol. Alcohol drinking leads to hypertension and increase the risk of aortic aneurysm.

• #2 Thoracic Aortic Diseases | University of Ottawa Heart Institute

  https://www.ottawaheart.ca/heart-condition/thoracic-aortic-diseases

  It is important for patients with aortic aneurysms to control the risk factors that can make the condition worse. Smoking and high blood pressure are the greatest concerns: […] Smokers must quit smoking. Patients may be referred to the Heart Institute Quit Smoking Program. A variety of aids and support are available to help with the quitting process. […] Blood pressure must be kept within normal limits (130/80). Adjustment of medications, a low sodium diet and exercise can achieve this. Patients should avoid heavy lifting and highly physical activities. […] Exercise is vital to maintaining good health. Patients with aortic aneurysms are advised to avoid strenuous lifting, pushing or pulling when there is straining involved. They can perform aerobic/cardio-type exercises eg. Walking, cycling, swimming, light jog, treadmill.

• #2 Thoracic Aortic Diseases | University of Ottawa Heart Institute

  https://www.ottawaheart.ca/heart-condition/thoracic-aortic-diseases

  Heart healthy diet with low fat and salt will prevent the build-up of plaque in the aorta and other arteries. Low salt (sodium) will help to lower blood pressure. […] Stress contributes to high blood pressure. Management of stress through exercise, yoga, mindfulness activities (meditation) and counselling are recommended. The Heart Institute offers stress management courses. […] Medical treatment involves regular imaging of the aorta and careful management of blood pressure to achieve a measurement 130/80 mmHg. Advice on appropriate exercise, diet, smoking cessation, and stress management are also provided.

• #2 Management of thoracic aortic aneurysm in adults – UpToDate

  https://www.uptodate.com/contents/management-of-thoracic-aortic-aneurysm-in-adults

  Management of thoracic aortic aneurysm in adults […] Conservative management of asymptomatic TAA aims to lessen stress on the aorta and limit further aortic expansion. Asymptomatic patients who do not meet the criteria for repair also require ongoing aneurysm surveillance. […] For patients who meet the criteria for repair, survival is improved for open surgery compared with medical therapy alone. This should also be the case for endovascular repair, given that endovascular repair compares favorably with open surgery. Asymptomatic patients with TAA who do not meet the criteria for repair are managed medically with routine surveillance.

• #2 Thoracic Aortic Aneurysms – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/diseases-of-the-aorta-and-its-branches/thoracic-aortic-aneurysms

  Most thoracic aortic aneurysms result from atherosclerosis. […] Risk factors for both thoracic aortic aneurysms and aortic dissections include prolonged hypertension, dyslipidemia, and smoking. Additional risk factors for TAAs include presence of aneurysms elsewhere in the body, infection, aortitis, and older age (peak incidence at age 65 to 70 years). […] Immediate control of hypertension is essential. Medical management with optimal control of hypertension, dyslipidemia, diabetes, and respiratory disease is the appropriate treatment until surgery is indicated. […] Asymptomatic aneurysms that do not meet criteria for elective surgical or endovascular repair are treated with aggressive blood pressure control using a beta-blocker and other antihypertensives if necessary. Smoking cessation is essential. Dyslipidemia, diabetes, and respiratory diseases should all be treated. […] Patients require frequent follow-ups to check for symptoms and serial CT or ultrasound every 6 to 12 months. Imaging frequency depends on aneurysm size.

• #2 Aortic Aneurysm: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/16742-aorta-aortic-aneurysm

  Having high blood pressure, high cholesterol or using tobacco products increases your risk of developing an aortic aneurysm. You can reduce your risk by maintaining a healthy lifestyle. This includes: […] Taking steps to improve your heart health can help prevent aortic aneurysms from developing or getting worse. Talk to your doctor about lifestyle changes you can make. If you’re at risk for an aortic aneurysm, be sure to get regular screenings. Finding and treating an aneurysm early greatly reduces the risk of rupture or other complications.

• #2 Thoracic Aortic Aneurysm: Symptoms, Causes, Treatment, More

  https://www.healthline.com/health/thoracic-aortic-aneurysm

  The majority of TAAs arent linked to family history. Thats why making lifestyle changes may help reduce your risk of this condition. Some ways that you may be able to prevent aneurysms include: quitting smoking, keeping your blood pressure under control, eating a balanced diet, minimizing your intake of trans fats and highly processed foods, getting a screening evaluation if you have a family history. […] Certain groups of people can benefit from screening for a TAA such as: people with a genetic syndrome associated with TAAs such as Marfan syndrome, people with a parent or sibling with a TAA or bicuspid aortic valve-associated TAA.

• #2 Prophylactic Surgery for Thoracic Aortic Aneurysm

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10106997/

  A 68-year-old man presented for evaluation of a 5.0-cm asymptomatic ascending aortic aneurysm. […] Given the possibility that his TAD might be heritable, the patient was advised to have his first-degree relatives screened with TTE or CTA to examine both the aortic root and ascending aorta. […] The typical threshold for prophylactic surgical replacement in cases of heritable TAD is an aortic diameter of 5.0 cm, as opposed to 5.5 cm for sporadic TAD. […] The optimal timing of prophylactic surgery to prevent potential aortic dissection or rupture depends heavily on the genetic context in which the aneurysm occurs, as heritable aneurysms tend to grow faster and dissect earlier. […] Because of the increased likelihood of these events among patients with HTAD compared to those with non-HTAD, they should be referred for prophylactic surgery at a maximal aortic diameter 5.0 cm.

• #2 Thoracic Aortic Aneurysm & Aortic Dissection | Marfan Foundation

  https://marfan.org/conditions/familial-aortic-aneurysm/

  Medications (drugs) that reduce the stress on the aorta can be helpful. Beta-blockers help lower blood pressure and reduce the force of the heartbeat. They also may help prevent or slow aortic enlargement and reduce the risk of aortic dissection. […] People with familial thoracic aortic aneurysm and dissection must have routine tests to monitor their aortic health and identify problems before there is an emergency. These are the same imaging tests that doctors use to diagnose the condition: echocardiogram, MRI, CT scan, or TEE. […] Surgery is most effective if it is done before an aortic dissection or other life-threatening situation. Surgery is considered when: The rate of enlargement of the ascending aorta approaches 0.5 cm per year; The diameter of the ascending aorta is between 4.2 and 5.0 cm (depending on the underlying mutation or family history). […] Regardless of which type of surgery is performed, patients must continue to take their blood pressure medicine and have their aorta monitored at least once a year to safeguard against additional enlargements or tears in other parts of the aorta.

• #2 Thoracic Aortic Aneurysms: At What Size Should We Intervene? – Endovascular Today

  https://evtoday.com/articles/2017-nov/thoracic-aortic-aneurysms-at-what-size-should-we-intervene

  Thoracic aortic aneurysm (TAA) is a potentially life-threatening disorder that without intervention carries a poor prognosis. […] Maximum aortic diameter is the key parameter used to predict rupture risk and is therefore central in directing clinicians whether to offer surveillance or surgical repair. […] Based on these findings, the authors suggested the threshold of 5.5 to 6 cm for prophylactic surgical aortic repair. […] The 2017 European Society for Vascular and Endovascular Surgery (ESVS) guidelines on descending thoracic aortic disease suggested that endovascular repair should be considered for descending TAAs 60 mm diameter, as this is the diameter where risk of rupture sharply escalates (classification IIa, level B evidence). […] The latest ESVS guidelines suggest that based on the size differential between men and women at baseline, the threshold can be reduced to 50 to 55 mm for women.

• #2 Current approaches to spinal cord protection during open thoracoabdominal aortic aneurysm repair – Coselli- Annals of Cardiothoracic Surgery

  https://www.annalscts.com/article/view/17014/html

  A critical element of preventing SCD is maintaining an adequate spinal cord perfusion pressure (SCPP), which is equal to the spinal arterial pressure minus the venous pressure. […] The goal is to maintain an SCPP that is at least 60 mmHg because values below that are associated with a higher SCD risk. […] The role of LHB was established in a retrospective study that showed an associated 63% relative risk reduction in SCD for patients undergoing extent II repair. […] In a recent series of patients from our center, LHB was used in 45% of TAAA repairs with a mean duration of 25 minutes. […] Typically, the intercostal and lumbar arteries are aggressively reimplanted in the T7/8 to L1/2 region and revascularized. […] RILA has been shown to be an independent predictor of reduced persistent and delayed SCD, cutting the SCD risk by about half.

• #2 Integrated Aortic Program | Thoracic Aneurysm Program

  https://www.valleyhealth.com/services/integrated-aortic-program

  Education is an important aspect of care, and we offer education on nutrition, stress management, and safe exercise with a thoracic aneurysm. We encourage patients and their families to reach out to our nurse practitioners at any time should any questions or concerns arise. […] Valleys Integrated Aortic Program has patient support groups that meet regularly online and in person. These groups provide a supportive environment for thoracic aortic aneurysm and aortic dissection patients to share stories, concerns and advice with fellow patients and their loved ones.

• #2 Prophylactic Surgery for Thoracic Aortic Aneurysm

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10106997/

  Certain high-risk features of HTAD may prompt the consideration of an earlier intervention. […] In cases of sporadic TAD, first-degree relatives should undergo screening aortic imaging, as up to 20% of patients with root or ascending aortic aneurysms may have a positive family history of TAD. […] The management of thoracic aortic aneurysm and the appropriate timing of prophylactic surgical aortic replacement to prevent potential dissection or rupture require careful characterization of the genetic risk factors for each patient.

• #2 Thoracic Aortic Aneurysm & Aortic Dissection | Marfan Foundation

  https://marfan.org/conditions/familial-aortic-aneurysm/

  A thoracic aortic aneurysm is an enlargement of the aorta (the main blood vessel that carries blood away from the heart to the rest of the body) in the thoracic cavity or the chest area. This condition is fairly common in the general population, but about 20 percent of the cases are caused by a genetic condition. […] Early detection, frequent imaging, and treatment are critical because both aortic aneurysms and dissections increase the risk that the aorta will suddenly burst (rupture), causing massive internal bleeding. Without surgery to prevent aortic rupture, these blood vessel abnormalities can be life-threatening. […] The management of familial thoracic aortic aneurysm and/or dissection requires the coordinated input from a multidisciplinary team of specialists familiar with this condition, including a medical geneticist, cardiologist, and cardiovascular surgeon.

• #2 Living With Aortic Aneurysm | Mass General Brigham

  https://www.massgeneralbrigham.org/en/about/newsroom/articles/living-with-aortic-aneurysm

  Quit smoking. According to the Centers for Disease Control and Prevention (CDC), a history of smoking accounts for about 75% of all abdominal aortic aneurysms. […] Stay active. Exercise, even simply walking, can improve the health of your arteries and heart. […] Maintain a healthy blood pressure. High blood pressure increases your risk of worsening aortic aneurysm. […] Control your cholesterol intake. Eat a heart-healthy diet by avoiding foods with high cholesterol, like beef, whole milk, baked goods, and fried foods. […] Medication can help improve your symptoms and prevent your aneurysm from getting worse. […] While there are possible risks to aortic aneurysm repair, your doctor may recommend surgery depending on the size of your aneurysm and how quickly it’s growing. […] Types of surgery for aortic aneurysm are: […] If you have an aortic aneurysm, it’s important to know the signs of a rupture. Getting treatment as quickly as possible may save your life. […] While all aneurysms are potentially serious, following your treatment plan can help you manage your symptoms and keep the condition from getting worse.

• #3 Thoracic Aortic Aneurysms: At What Size Should We Intervene? – Endovascular Today

  https://evtoday.com/articles/2017-nov/thoracic-aortic-aneurysms-at-what-size-should-we-intervene

  Symptomatic aneurysms and aneurysms associated with a rapid growth rate of 1 cm per year should also be repaired because of an increased risk for rupture. […] Current guidelines for repair suggest the threshold for prophylactic surgical aortic repair to be within the range of 5.5 to 6 cm, but the decision regarding which individual will benefit from repair remains challenging. […] At present, it seems that there is no one-size-fits-all treatment, and therefore, patient selection should be performed on an individual basis according to morphological complexities, comorbidities, and anticipated overall survival and durability of any repair.

• #3 Current approaches to spinal cord protection during open thoracoabdominal aortic aneurysm repair – Coselli- Annals of Cardiothoracic Surgery

  https://www.annalscts.com/article/view/17014/html

  Postoperative management after TAAA repair must complement the operative procedure. General guiding principles include maintaining a satisfactory MAP with adequate volume resuscitation and cardiac index, CSFD management, optimal hemoglobin thresholds, adequate oxygenation in the early postoperative period to ensure adequate spinal cord oxygen delivery, and careful multidisciplinary critical care. […] Delayed paraplegia is defined as SCD that develops later in the postoperative period after the patient has awakened from anesthesia appearing neurologically intact after TAAA repair. […] Our current approach to delayed paraplegia is outlined in Figure 3. […] TAAA repair is associated with a significant risk of SCD. Over the course of several decades, multiple surgical adjuncts and strategies have been developed that have reduced the risk of SCD substantially when performed by experienced surgeons and teams.

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