Thoracic aortic aneurysm natural history, complications and prognosis

Thoracic aortic aneurysm Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aarti Narayan, M.B.B.S [2]

Complications

Dissection

Aortic dissection is one of the most feared complications of an aortic aneurysm. Patients who have a prior dissection as a cause of an aneurysm are at increased risk of rapid expansion in re-dissection of the aneurysm.

Bleeding

complication for all aneurysm repairs

Neurologic injuries

• Stroke- major cause of mortality
• Due to an obstructed blood vessel of atherosclerotic debris
• Patients undergoing arch repairs are at the highest risk

Cardiac and pulmonary failure (acute respiratory distress syndrome)

Myocardial infarction

• Due to technical problems with coronary ostia implantation during root replacement for ascending aortic aneurysms; may require reoperation
• Pulmonary and renal dysfunction are also morbid complications:

Paraparesis and paraplegia-

• Complications due to thoracic and thoracoabdmonial aneurysm repairs

Endovascular stenting complications

• Endoleaks
• Stent fractures
• Stent graft migration or thromobosis
• Iliac artery rupture
• Retrograde dissection
• Microembolization
• Aortoesophageal fistula

Prognosis

Factors responsible for worsening prognosis are:

• Diastolic dysfuncrion
• Traumatic aneurysm
• Associated coronary artery disease
• Carotid artery disease