Thoracic aortic aneurysm: unlocking the “silent killer” secrets

Abstract

Thoracic aortic aneurysm (TAA) is an increasingly recognized condition that is often diagnosed incidentally. This review discusses ten of the most relevant epidemiological and clinical secrets of this disease; (1) the difference in pathogenesis between ascending and descending TAAs. TAAs at these two sites act as different diseases, which is related to the different embryologic origins of the ascending and descending aorta. (2) The familial pattern and genetics of thoracic aneurysms. Syndromic TAAs only explain 5% of the pattern of inheritance. (3) The effect of female sex on TAA growth and outcome. Females have been found to have worse outcomes compared to males. (4) Guilt by Association. TAAs are associated with abdominal aortic aneurysms, intracranial aneurysms, bicuspid aortic valve, and inflammatory disorders. (5) Natural history of TAAs. Important findings have been made regarding the expansion rate (in relation to familial pattern, location and size), and also regarding the risk of rupture or dissection. (6) The aortic size paradox. Size only is not a sufficient predictor of risk of dissection. (7) Biomarker void. Although many serum biomarkers have been studied, imaging remains the only reliable method for diagnosis and follow-up. (8) Indications for repair. Decisions are made depending on symptoms, location, size, and familial patterns. (9) Types of repair. Both open and endovascular repair options are available for certain TAAs. (10) Medical treatment. The efficacy of prescribing beta blockers, angiotensin converting enzyme inhibitors or angiotensin receptor blockers remains dubious.

Biomechanics of aortic wall failure with a focus on dissection and aneurysm: A review

“…1 therein. Even though it has been shown that the risk of rupture and dissection of aneurysms increase significantly at sizes larger than 6 cm for the thoracic aorta [26], this criterion is in contradiction with the observation that aneurysms can rupture or dissect at any diameter [11,98,154,97,117], and it ignores the more complex relationships between the rupture and the material properties such as the heterogeneity of tensile strength in the wall of aortic aneurysms [149]. Clinicians need more reliable tools to assess the risk of intervention versus the risk of rupture, as the maximum diameter criterion can underestimate the rupture risk of smaller aneurysms, and overestimate it for the larger ones.…”

“…Aortic aneurysms are local dilatations of the aorta, typically more than 50% of the normal diameter [41]. The underlying mechanisms leading to aneurysm formation differ between the ascending aorta and the descending thoracic aorta [117], as well as between the thoracic and the abdominal aorta [33,116,14] due to different embryonic origins of the cells involved in the remodeling process. The aneurysms in the ascending aorta are usually not accompanied by atherosclerosis, whereas in the descending thoracic and the abdominal aorta it is a common finding [57].…”

High heritability of ascending aortic diameter and multi-ethnic prediction of thoracic aortic disease.

“…Body surface area is a primary determinant of thoracic aortic size, which increases in diameter with the physiological demands that accompany normal growth throughout childhood and into adult life 2 . Extremes in thoracic aortic diameter can manifest in clinically significant disease ranging from thoracic aortic dilation or aneurysm which may be asymptomatic until the occurrence of rupture or dissection [3][4][5] .…”

LncRNA Sox2ot modulates the progression of thoracic aortic aneurysm by regulating miR-330-5p/Myh11

“…TAA mainly occurs after the age of 60, and male patients occupy 80% of TAA cases [ 2 , 3 ]. Most of the TAA cases are caused by the deterioration of atherosclerosis, and a few cases are caused by syphilis [ 3 , 4 ]. Meanwhile, surgical treatment has become the most effective therapy for TAA.…”