Those descending thoracic aortic aneurysms that are symptomatic usually illicit chronic chest pain, originating from erosion or compression of adjacent structures, that may radiate into the neck, shoulder, or back. Compression of the left recurrent laryngeal nerve may produce hoarseness, and esophageal compression can result in dysphagia. Patients with descending thoracic aortic aneurysms will occasionally report a tearing sensation if the artery is dissecting, which is a loosening of the layers of the artery wall, allowing blood to flow in between. A pulsatile mass may also be noted. Aortic aneurysms carry the risk for thrombus formation, which may develop along the inner wall of the aneurysm, and distal emboli may produce a cerebrovascular accident, limb or digit ischemia, or an acute abdomen.
Definitive treatment consists of surgical repair or replacement of the diseased blood vessel.
Large aneurysms are repaired by replacing the dilated segment of the aorta with a prosthetic Dacron graft. Partial circulatory support of the lower extremity and visceral vessels is frequently used for repair of the descending thoracic aneurysm. A direct relationship exists between the aortic aneurysm size and the risk for rupture. Patients with descending thoracic aortic aneurysms greater than 6 cm in length should be considered for elective surgery, since these aneurysms frequently expand without symptoms and are prone to rupture, with its high morbidity rate from exsanguination. Since Mr. K's aneurysm easily exceeds this size, he was counseled by his family doctor that this is his best option.