From the Guidelines
Yes, aortic arch aneurysms can result in neck changes, as they can compress or displace surrounding structures in the neck and upper chest, leading to visible or palpable changes. These changes may include a pulsatile mass in the supraclavicular area, visible swelling at the base of the neck, distended neck veins due to compression of the superior vena cava, or hoarseness caused by pressure on the recurrent laryngeal nerve, as noted in the 2022 ACC/AHA guideline for the diagnosis and management of aortic disease 1. Patients might also experience difficulty swallowing (dysphagia) if the aneurysm compresses the esophagus, or shortness of breath if it affects the trachea.
Key Considerations
- The anatomical proximity of the aortic arch to neck structures explains these findings, as the arch sits just behind the manubrium of the sternum and extends upward toward the neck base.
- These neck manifestations typically occur in larger aneurysms (generally greater than 5-6 cm) and represent advanced disease requiring urgent medical attention, as indicated by the 2024 ESC guidelines for the management of peripheral arterial and aortic diseases 1.
- Any patient presenting with unexplained neck changes, especially if accompanied by chest pain, back pain, or difficulty breathing, should be evaluated promptly for possible aortic pathology, according to the 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease 1.
Clinical Implications
- Aortic diameter is the primary risk factor for aortic events, and evidence supports diameter indexation, as well as the use of aortic length, growth rate, and age/sex for risk assessment, as discussed in the 2024 ESC guidelines 1.
- Multidisciplinary collaboration, hybrid operating rooms, and advanced stent technology have increased the adoption of hybrid approaches and endovascular therapies for different thoracoabdominal aortic diseases, highlighting the importance of timely and appropriate management.
From the Research
Aortic Arch Aneurysms and Neck Changes
- Aortic arch aneurysms can lead to various complications, including those affecting the neck region 2.
- The treatment of aortic arch aneurysms often involves endovascular repair or surgical intervention, which may require modifications to the neck anatomy, such as cervical debranching of the arch vessels 2.
- Studies have shown that endovascular repair of aortic arch aneurysms can be effective in preventing further complications, including those related to the neck region 2.
- However, the relationship between aortic arch aneurysms and specific neck changes is not explicitly stated in the available evidence.
Anatomic Features and Outcomes
- Aortic neck anatomic features can predict outcomes in endovascular repair of abdominal aortic aneurysms 3.
- Features such as neck angle and length can influence the risk of complications, including early and late type I endoleak, early intervention, and late death 3.
- While these findings are related to abdominal aortic aneurysms, they may have implications for the treatment of aortic arch aneurysms and potential neck changes.
Treatment Advances
- Advances in the treatment of degenerative aortic arch aneurysms have been made over the last decade, including the use of endovascular technologies and modifications to surgical techniques 4.
- These advances aim to reduce the risk of complications, including neurocognitive dysfunction and ischemic spinal cord injury 4.
- However, the specific relationship between these treatment advances and potential neck changes is not explicitly stated in the available evidence.