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a cardiovascular disease characterized by a saclike widening of an artery resulting from weakening of the artery wall (同)aneurism

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胸の,胸部の
動脈瘤(りゅう)

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/05/26 17:16:44」(JST)

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A thoracic aortic aneurysm is an aortic aneurysm that presents primarily in the thorax.

A thoracic aortic aneurysm is the "ballooning" of the upper aspect of the aorta, above the diaphragm. Untreated or unrecognized they can be fatal due to dissection or "popping" of the aneurysm leading to nearly instant death. Thoracic aneurysms are less common than an abdominal aortic aneurysm.^[1] However, a syphilitic aneurysm is more likely to be a thoracic aortic aneurysm than an abdominal aortic aneurysm.

A contrast enhanced CT demonstrating a large thoracic aneurysm of about 7 cm which has ruptured.

Causes

There are a number of causes, ^[2] Aneurysms in patients younger than 40 usually involve the ascending aorta due to a weakening of the aortic wall associated with connective tissue disorders like the Marfan and Ehler-Danlos syndromes or congenital bicuspid aortic valve. Younger patients may develop aortic aneurysms of the thoracoabdominal aorta after an aortic dissection. It can also be caused by blunt injury.

Atherosclerosis is the principal cause of descending aortic aneurysms, while aneurysms of the aortic arch may be due to dissection, atherosclerosis or inflammation.

Age

The diagnosis of thoracic aortic aneurysm usually involves patients in their 60s and 70s.

Risk factors

Hypertension and cigarette smoking are the most important risk factors, though the importance of genetic factors has been increasingly recognized. Approximately 10% of patients may have other family members who have aortic aneurysms. It is also important to note that individuals with a history of aneurysms in other parts of the body have a higher chance of developing a thoracic aortic aneurysm.^[3]

Screening

Guidelines were issued in March 2010 for early detection of thoracic aortic disease, by the American College of Cardiology, the American Heart Association, and other groups. Among the recommendations:

First-degree relatives of people with thoracic aortic aneurysm or dissection should have aortic imaging to identify asymptomatic disease.
People with symptoms suggestive of thoracic aortic dissection should be routinely evaluated "to establish a pretest risk of disease that can then be used to guide diagnostic decisions."
People diagnosed with Marfan syndrome should immediately have an echocardiogram to measure the aorta, and followed up 6 months later to check for aortic enlargement.^[4]

Treatment

A stent graft placed in the thoracic aorta to treat a thoracic aortic aneurysm.

Thoracic Aortic Aneurysm. Animation in the reference

The size cut off for aortic aneurysm is crucial to its treatment. A thoracic aorta greater than 4.5 cm is defined as aneurysmal, while a size greater than 6 cm is the distinction for treatment, which can be either endovascular or surgical, with the former reserved for pathology at the descending aorta.^[5]

Indication for surgery may depend upon the size of the aneurysm. Aneurysms in the ascending aorta may require surgery at a smaller size than aneurysms in the descending aorta.^[6]

Treatment may be via open or via endovascular means.

Complications

The principal causes of death due to thoracic aneurysmal disease are dissection and rupture. Once rupture occurs, the mortality rate is 50–80%, and most deaths in patients with the Marfan syndrome are the result of aortic disease.

Epidemiology

Each year in the United States, some 45,000 people die from diseases of the aorta and its branches. Acute aortic dissection, a life-threatening event due to a tear in the aortic wall, affects 5 to 10 patients per million population each year, most often men between the ages of 50 and 70; of those that occur in women younger than 40, nearly half arise during pregnancy. The majority of these deaths occur as a result of complications of thoracic aneurysmal disease.

References

^ Thoracic Aortic Aneurysm at eMedicine
^ Aneurysms: Aneurysms and Aortic Dissection at Merck Manual of Diagnosis and Therapy Home Edition
^ Thoracic Aortic Disease - Northwestern Memorial Hospital. Thoracic Aortic Aneurysm
^ Hiratzka LF, Bakris GL, Beckman JA, et al. (April 2010). "2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the diagnosis and management of patients with thoracic aortic disease. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology,American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons,and Society for Vascular Medicine". J. Am. Coll. Cardiol. 55 (14): e27–e129. doi:10.1016/j.jacc.2010.02.015. PMID 20359588.
^ Makaroun MS, Dillavou ED, Kee ST, et al. (January 2005). "Endovascular treatment of thoracic aortic aneurysms: results of the phase II multicenter trial of the GORE TAG thoracic endoprosthesis". J. Vasc. Surg. 41 (1): 1–9. doi:10.1016/j.jvs.2004.10.046. PMID 15696036.
^ "Treatment Considerations related to Thoracic Aortic Aneurysm". Retrieved 2010-10-23.

UpToDate Contents

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1. 胸部大動脈瘤のマネージメントおよび転帰 management and outcome of thoracic aortic aneurysm
2. 胸部大動脈瘤の臨床症状および診断 clinical manifestations and diagnosis of thoracic aortic aneurysm
3. 胸部大動脈瘤の疫学、危険因子、病因、および自然史 epidemiology risk factors pathogenesis and natural history of thoracic aortic aneurysm
4. 腹部大動脈瘤ステントグラフト留置術に対する麻酔 anesthesia for endovascular aortic repair
5. 胸部大動脈の動脈瘤修復 endovascular repair of the thoracic aorta

English Journal

Recurrent inflammatory aortic aneurysms in chronic mucocutaneous candidiasis with a gain-of-function STAT1 mutation.

Tanimura M1, Dohi K2, Hirayama M3, Sato Y1, Sugiura E1, Nakajima H1, Kanemitsu S4, Toyoda H3, Yamada N1, Masuya M5, Imanaka-Yoshida K6, Shimpo H4, Azuma E7, Ito M1.
International journal of cardiology.Int J Cardiol.2015 Oct 1;196:88-90. doi: 10.1016/j.ijcard.2015.05.183. Epub 2015 Jun 4.
PMID 26080282

Aortic valve stenosis: non-invasive preoperative evaluation using 64-slice CT angiography.

Ciolina F1, Sedati P, Zaccagna F, Galea N, Noce V, Miraldi F, Cavarretta E, Francone M, Carbone I.
The Journal of cardiovascular surgery.J Cardiovasc Surg (Torino).2015 Oct;56(5):799-808.
AIM: In patients affected by aortic valve stenosis (AS) it is mandatory to rule out coronary artery disease (CAD). The role of retrospectively ECG-gated 64-slice CT angiography (64-SCTA) was assessed in patients with AS referred for surgical valve replacement.METHODS: Forty-two patients with AS unde
PMID 26088011

Clinical utility of a next generation sequencing panel assay for Marfan and Marfan-like syndromes featuring aortopathy.

Wooderchak-Donahue W1,2, VanSant-Webb C1, Tvrdik T1, Plant P1, Lewis T1, Stocks J1, Raney JA1, Meyers L3, Berg A3, Rope AF4, Yetman AT5, Bleyl SB5,6, Mesley R7, Bull DA7, Collins RT8, Ojeda MM9, Roberts A9, Lacro R9, Woerner A10, Stoler J10, Bayrak-Toydemir P1,2.
American journal of medical genetics. Part A.Am J Med Genet A.2015 Aug;167(8):1747-57. doi: 10.1002/ajmg.a.37085. Epub 2015 May 5.
Aortopathy can be defined as aortic dilation, aneurysm, dissection, and tortuosity. Familial aortopathy may occur secondary to fibrillin-1 (FBN1) mutations in the setting of Marfan syndrome, or may occur as a result of other genetic defects with different, but occasionally overlapping, phenotypes. B
PMID 25944730

Japanese Journal

レボドパ静注で管理した重症パーキンソン病患者における上行大動脈人工血管置換術の経験

寺島聡子,柳田有利奈,伊藤伸大 [他]
麻酔 64(8), 845-848, 2015-08
NAID 40020554992

症例広範囲胸部大動脈瘤に対する二期的ハイブリッド手術の1例

林太郎,戸部智,杉山博信 [他]
胸部外科 = The Japanese journal of thoracic
NAID 40020521867

胸部外科の指針感染性大動脈瘤の治療経験

大澤久慶,村木里誌,櫻田卓 [他]
胸部外科 = The Japanese journal of thoracic
NAID 40020521743

Related Pictures

★リンクテーブル★

リンク元	「胸部大動脈瘤」「TAA」「thoracoabdominal aortic aneurysm」
関連記事	「thoracic」「aortic」

「胸部大動脈瘤」

Thoracic aortic aneurysm
	Thoracic aortic aneurysm with arrow marking the lateral border of the aorta.
Classification and external resources
Specialty	cardiology
ICD-10	I71.1, I71.2
ICD-9-CM	441.1, 441.2
MedlinePlus	001119
eMedicine	article/761627 article/424904 article/418480
MeSH	D017545
	[edit on Wikidata]