Aortic Disease

(Aortic aneurysm, aortic dissection, occlusive disease)

The aorta is the largest blood vessel in the body leading from the heart to all of the important organs of the body including the brain and also to the arms and legs.

An aneurysm is an abnormal enlargement or bulging of the wall of an aorta, caused by damage or weakness in the blood vessel wall. When aneurysms grow too large, they can rupture and the bleeding can be life-threatening. Aneurysms of the chest/abdomen are treated by Vascular Surgeons whereas, aneurysms near the heart (ascending aorta and aortic arch), are treated by Cardiothoracic Surgeons. Aneurysms that have grown too large should be repaired. Abdominal aortic aneurysm is also called AAA.

A dissection is a tearing of the layers of the aorta. These tears can lead to blockages of the branching vessels that lead to important parts of the body. This damage also weakens the vessels and can lead to aneurysms.

Signs and symptoms of aortic aneurysm/dissection include: Pulsating mass of the abdomen. Ask your doctor about this for a possible referral to a Vascular Surgeon. Symptoms requiring emergent medical attention/calling 911 would be a sudden severe and tearing pain of the abdomen spreading to the back.

Risk factors for aortic aneurysms or dissections include: Smoking/nicotine use, high blood pressure (hypertension), use of stimulant drugs (cocaine/meth), or family history of connective tissue disorders (e.g. Marfan, Ehlers-Danlos).

Testing includes: Abdominal ultrasounds and CT angio scans.

If you are older than 65 years old and have had any history of smoking, it is recommended you are screened for AAA.

Treatment:

Traditionally, open aortic repair is a major surgical procedure performed by Vascular Surgeons, after which patients stay in the hospital for about a week in recovery before discharge. The aorta is repaired by making an incision on the abdomen so that the vessel can be repaired directly with surgical techniques and an implanted graft to replace it.

A minimally invasive approach is a possibility for some patients and utilizes endovascular technologies (EVAR/TEVAR). This would be a percutaneous procedure only involving small incisions and recovery is generally much shorter for patients with most able to discharge home the next day. A covered stent graft is used to re-line the aorta so the aneurysm sac is no longer pressurized and at high risk for rupture.

We offer all of these procedures and our surgeons are happy to discuss which is right for you.