Aneurysm of the aortic arch
Introduction
An aortic arch aneurysm is a dangerous condition for a person due to the risk of rupture. The aorta is the largest artery in the body and carries blood throughout the body. The aortic arch is the section of the aorta located between the ascending aorta and the descending aorta, and its primary function is to supply blood to the vessels of the brain and upper limbs.
In the event that an aneurysm forms in the aortic arch, its diagnosis is of vital importance, as its rupture is very dangerous for the patient's health. Unfortunately, an aortic arch aneurysm is mainly asymptomatic and is diagnosed incidentally after a chest X-ray or through an ultrasound performed for other reasons.
The timely early diagnosis of the disease
is very important
for the good outcome of the condition in both stages of the disease.
Ανεύρισμα αορτικού τόξου: Χειρουργικές μέθοδοι
Understanding the aortic arch aneurysm
The aortic arch is the section of the aorta that begins from the aortic valve and ends after an arch-like curve at the thoracic aorta, where it runs through the chest in front of the spinal column.
The main factors causing aortic arch aneurysms are aortic dissection (type A), smoking, arterial hypertension as well as rare genetic disorders of the connective tissue (e.g. Marfan syndrome, Ehlers-Danlos etc.).
Σε περίπτωση μη αντιμετώπισης ενός ανευρύσματος είτε οφείλεται σε διαχωρισμό (διαχωριστικό ανεύρυσμα) είτε σε διάταση όλου του αγγείου, η κύρια επιπλοκή είναι η ρήξη και ο θάνατος του ασθενούς.
Treatment options for the aortic arch aneurysm
The aortic arch aneurysm is treated mostly open surgically via sternotomy by cardiac surgery teams. In recent years however, the minimally invasive methods (endovascular method with stent) with excellent clinical results especially in patients who have already undergone a previous sternotomy. Specifically, endovascular repair is indicated in the following cases (provided that the anatomy allows it):
- Dissecting or non-dissecting aneurysm of the aortic arch where a previous replacement of the ascending aorta has been performed
- Saccular aneurysms of the aortic arch
- Aneurysms of the aortic arch or the thoracic aorta with a normal ascending aorta.
The role of the vascular surgeon
The treatment of the aortic arch with minimally invasive methods is a particularly demanding procedure that few centers worldwide are able to offer. Our vascular surgery clinic at Athens Medical Center is among these centers. With many years of experience and specialization in the treatment of complex vascular conditions, the Vascular Surgeon, Dr. Bisdas, safely manages each individual case. The most important criterion for patient selection is the presence of the so-called Aortic Team where the indication, the diagnosis and the treatment will be discussed in a joint council of cardiac and vascular surgeons with the aim of the safest possible procedure for the patient..
Frequently Asked Questions (FAQs)
What is the aortic arch?
The aortic arch is the section of the aorta that begins after the ascending aorta and curves backward and downward. From it arise the large vessels that supply blood to the brain, neck and upper limbs: the innominate artery, the left carotid artery and the left subclavian artery. It constitutes a central key point of circulation.
What does "aortic arch prominence" or "aortic knob prominence" mean?
The term "prominence" describes the impression that the aortic arch gives on a chest X-ray when it projects more than normal. The aortic knob is the shadow of the aortic arch on the left border of the heart. The prominence may be a normal finding in elderly individuals or may be associated with pathological conditions, such as hypertension or aneurysm.
What is calcification or calcification of the aortic arch?
Calcification of the aortic arch is the deposition of calcium in the wall of the aorta. It occurs frequently in elderly individuals or in patients with atherosclerosis, hypertension and diabetes mellitus. Although it may be an incidental finding on imaging, it indicates chronic damage to the vascular wall and increased cardiovascular risk.
What are the normal dimensions of the ascending aorta and the aortic arch?
The ascending aorta normally has a diameter of approximately 2.5–3.5 centimeters in adults, with small variations depending on sex and body type. The aortic arch has a slightly smaller diameter, around 2.5–3 centimeters. When the dimensions exceed 4 centimeters it is considered a disorder, while above 5 centimeters there is an indication for monitoring or treatment.Sonnet 4.6
How is the aortic arch visualized on an X-ray?
On a plain chest X-ray, the aortic arch forms the well-known "aortic knob", that is a curved shadow on the left outline of the mediastinum. Its prominence may become more apparent in individuals with hypertension, age-related changes or an aneurysm. For accurate measurement of dimensions, examinations such as CT scan or MRI are required.Sonnet 4.6
How is the aortic arch treated?
The treatment of the aortic arch depends on whether there is a pathology, such as an aneurysm or dissection. Traditionally, treatment was performed with open surgery, which remains the most radical method. However, in recent years new endovascular techniques have been developed (TEVAR – Thoracic Endovascular Aortic Repair), where endoprostheses are placed with a catheter via the femoral artery. These methods are less invasive, reduce recovery time and offer solutions to high-risk patients. The choice of method depends on the size, location, general health of the patient and the experience of the medical team.
