Treatment

The goal of treatment is to prevent your aneurysm from growing and to treat it before it dissects or ruptures. Depending on the size and growth rate of your thoracic aortic aneurysm, treatment may vary from watchful waiting (monitoring) to surgery.

Monitoring

If your thoracic aortic aneurysm is small, your doctor may recommend imaging tests to monitor the aneurysm, along with medication and management of other medical conditions.

Usually, you'll have an echocardiogram, CT or magnetic resonance angiography (MRA) scan at least six months after your aneurysm is diagnosed, and at regular follow-up exams. How often you have these tests done depends on the cause and size of the aneurysm, and how fast it's growing.

Medications

If you have high blood pressure or blockages in your arteries, your doctor will likely prescribe medications to lower your blood pressure and cholesterol.

These medications could include:

• Beta blockers. Beta blockers lower your blood pressure by slowing your heart rate. For people with Marfan syndrome, beta blockers may reduce how fast the aorta is widening. Examples of beta blockers include metoprolol (Lopressor, Toprol-XL, Kapspargo Sprinkle), atenolol (Tenormin) and bisoprolol.
• 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 often 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 (Altoprev), simvastatin (Zocor, FloLipid) and others.

If you smoke or chew tobacco, it's important that you quit. Using tobacco can worsen your aneurysm.

Surgery

Surgery is generally recommended for thoracic aortic aneurysms about 1.9 to 2.4 inches (about 5 to 6 centimeters) and larger. If you have Marfan syndrome, another connective tissue disease, a bicuspid aortic valve or a family history of aortic dissection, your doctor may recommend surgery for smaller aneurysms due to the higher risk of aortic dissection.

Most people with a thoracic aortic aneurysm have open-chest surgery, but in some select cases your doctor may determine you're a candidate for a less invasive repair called endovascular surgery.

The type of surgery you have depends on your condition and the location of your thoracic aortic aneurysm.

• Open-chest surgery. Open-chest surgery to repair a thoracic aortic aneurysm generally involves removing the damaged section of the aorta and replacing it with a synthetic tube (graft), which is sewn into place. It generally takes a month or more to fully recover from this procedure. If you have Marfan syndrome or other related conditions, you may have aortic root replacement. Your surgeon removes a section of your aorta and sometimes the aortic valve and replaces the section of the aorta with a graft. The aortic valve may be replaced with a mechanical or biological valve. If the valve is not removed, the surgery is called valve-sparing aortic root repair.
• Endovascular surgery. Doctors attach a synthetic graft to the end of a thin tube 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. Small hooks or pins keep the graft in place. 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-chest surgery, but endovascular surgery can't be done on everyone. Ask your doctor whether it's right for you. After endovascular surgery, you'll need to have regular follow-up imaging scans to ensure that the graft isn't leaking.
• Emergency surgery. Although it's possible to repair a ruptured aortic aneurysm with emergency surgery, the risk is much higher and there is a greater chance of complications. Because of this, doctors prefer to identify and treat thoracic aortic aneurysms before they rupture, and to follow through with lifelong monitoring and appropriate preventive surgery.