Thoracic Aortic Aneurysm in Nice
Dr. Ilya Khantalin – Vascular Surgeon in the Alpes-Maritimes
Treatment of Thoracic Aortic Aneurysm
Dr. Ilya Khantalin – Saint-Laurent-du-Var
A thoracic aortic aneurysm (TAA) is a major vascular pathology involving the thoracic segment of the aorta.
It is characterized by an abnormal dilation — a significant increase in diameter and a loss of parallelism in the aortic wall within the thoracic region.
Arterial diseases are now managed using modern techniques validated by the Haute Autorité de Santé (French National Health Authority), with a care approach based on innovation and adherence to recognized surgical protocols.
Dr. Ilya Khantalin, a vascular surgery specialist based in Saint-Laurent-du-Var, provides information below on this condition, its causes, available treatments, and follow-up procedures.
Vascular diseases are classified as Long-Term Illnesses (Affections de Longue Durée – ALD) in France, meaning they are fully covered (100%) by the national health insurance system.
What is a Thoracic Aortic Aneurysm?
Vascular Surgeon in Saint-Laurent-du-Var
A thoracic aortic aneurysm refers to a localized and progressive dilation of the aorta in its thoracic section. As this dilation progresses, the aortic wall weakens, increasing the risk of rupture—a life-threatening complication.
The size (especially if >55 mm) and growth rate of the aneurysm are the primary indicators of rupture risk and guide treatment decisions.
Thoracic aortic aneurysms can be classified into several subtypes based on their precise anatomical location:
- Ascending Aortic Aneurysm: Located above the heart, in the ascending portion of the aorta.
- Aortic Arch Aneurysm: Involving the curved part of the thoracic aorta near the origin of the supra-aortic trunks.
- Descending Thoracic Aortic Aneurysm: Found between the left subclavian artery and the diaphragm.
Diagnosis and Treatment of Thoracic Aortic Aneurysm
Specialist in Vascular Surgery – Saint-Laurent-du-Var
Causes and Risk Factors
Multiple conditions predispose to thoracic aortic aneurysm formation. The most common causes and risk factors include:
- High blood pressure (hypertension): Exerts chronic stress on the arterial walls, progressively weakening the aorta.
- Atherosclerosis: The buildup of fatty plaques stiffens arterial walls and makes them prone to dilation.
- Genetic disorders: Inherited diseases like Marfan syndrome or Ehlers-Danlos syndrome weaken connective tissue, increasing aneurysm risk.
- Smoking: A major risk factor that promotes atherosclerosis and arterial wall degeneration.
- Family history: Having relatives with aneurysms increases your own risk.
Symptoms of Thoracic Aortic Aneurysm
Many thoracic aortic aneurysms are asymptomatic, especially when small. However, as the aneurysm enlarges, certain symptoms may appear:
- Persistent chest or back pain
- Breathing difficulties due to airway compression or pleural effusion
- Chronic cough or changes in voice
- Dysphagia (difficulty swallowing), if the esophagus is compressed
These signs warrant urgent medical evaluation, as they may indicate an elevated risk of rupture.
Diagnostic Imaging
Diagnosis relies on imaging to assess the aneurysm’s size, location, and morphology. Commonly used tests include:
- CT Angiography (Angio-CT): The gold standard for precise anatomical assessment.
- Magnetic Resonance Imaging (MRI): Offers detailed, radiation-free imaging.
- Transesophageal Echocardiography (TEE): Useful for evaluating ascending and arch aneurysms.
- Angiography: An invasive technique using contrast dye to visualize blood flow and assess vascular structures.
Treatment Options
The choice of treatment depends on the aneurysm’s size, growth rate, and the patient’s overall health. Management options include medical monitoring, endovascular repair, and open surgical repair.
Medical Management & Surveillance
For small (<5 cm), asymptomatic aneurysms, close monitoring is often recommended. This involves:
- Regular imaging (CT or MRI)
- Blood pressure control (e.g., beta-blockers)
- Smoking cessation
- Cholesterol reduction (e.g., statins) to slow atherosclerosis
Surgical Intervention
Surgery is indicated in cases such as:
- Aneurysm >5.5 cm in men or >5 cm in women
- Rapid growth (>0.5 cm/year)
- Symptomatic aneurysms or those impairing quality of life
Two main surgical approaches:
- Endovascular Aneurysm Repair (TEVAR):
A minimally invasive procedure in which a stent graft is inserted into the aorta to reinforce the wall and prevent rupture. TEVAR is currently the preferred method due to its low operative risk and rapid recovery. - Open Surgical Repair: This involves replacing the aneurysmal segment with a synthetic graft via thoracotomy and cardiopulmonary bypass. Although more invasive, it remains the gold standard for complex cases. However, risks include bleeding, paraplegia, renal failure, and stroke.
Postoperative Follow-Up
Long-term follow-up is crucial after treatment to monitor for complications or recurrence:
- Routine Angio-CT scans to check graft or stent condition
- Doppler ultrasound of supra-aortic trunks (TSAo)
- Continued control of hypertension, cholesterol, and lifestyle factors
Patients are advised to:
- Quit smoking entirely
- Engage in moderate physical activity
- Follow a heart-healthy diet
A Life-Threatening but Manageable Condition
Thoracic aortic aneurysms carry significant risk but can be managed effectively with appropriate follow-up and timely treatment. If you have a family history, hypertension, or symptoms suggestive of a TAA, consult a vascular specialist.
Dr. Ilya Khantalin, vascular surgeon in Saint-Laurent-du-Var, offers precise diagnosis, risk assessment, and personalized care to ensure your vascular health and safety.