The body’s largest blood vessel, the aorta carries the blood pumped from the heart to the rest of the body. Because it is under high pressure, a problem with the aortic wall is potentially lethal.
The two most common aortic conditions are aneurysm (a weak area in the wall of the aorta that bulges outwards) and dissection (a tear in the inner lining of the aorta that allows blood in between the layers of the blood vessel). Treatment procedures either support or replace the damaged area to reduce the risk of a rupture.
Aortic Replacement, Repair, Reconstruction, or Remodeling
When the aortic condition is severe or complex, surgery (to completely remove the damaged section of vessel and replace it with a synthetic graft) may be the best option. In some cases, the entire aortic arch may need to be replaced. Surgeons can also repair or remodel nearby sections of the aorta that appear to be in danger.
Procedures to repair and replace the aorta are highly specialized. At Temple, some aortic repairs can now be accomplished with endovascular techniques and new devices. Larger aortic repairs often require open surgery and sternotomy.
Endovascular Aortic Repair (EVAR)
Penetrating aortic ulcers and intramural hematomas of the thoracic aorta are potentially dangerous and treated aggressively by Temple cardiovascular and vascular surgeons usually by an endovascular procedure. Aortic aneurysm or dissection can often be repaired by placement of a strong, tight-fitting mesh tube (stent) inside the vessel to support it. In this minimally invasive procedure, a surgeon guides the folded-up stent through the blood vessels to the site of the damage using a catheter. The stent then opens and is secured against the aortic wall, fixing the problem from the inside. This procedure is sometimes called thoracic EVAR, or TEVAR.
Hybrid Aortic Procedures
For patients with more complex conditions, open surgical repair of the aorta may be combined with another catheter-based procedure. For example, the patient might have surgery to repair an aneurysm in the ascending aorta, then an endovascular stent to strengthen the descending aorta. These hybrid procedures avoid multiple open surgeries and associated complications, and may be safer, and offer faster recovery.
Treatment of Related Heart Complications
If another heart problem contributes to the patient’s aortic condition, or vice versa, a Temple surgeon may recommend additional procedures or surgeries such as heart valve surgery, angioplasty, or insertion of a pacemaker or circulatory assist device. Some of these procedures can be done at the same time as the aortic arch surgeries mentioned above. Others are done as a follow-up. Many can now be performed using minimally invasive techniques.
Repairs to the thoracic aortic can be complex for many reasons. As a specialist center, the Temple Heart & Vascular Institute has access to sophisticated facilities—including hybrid operating rooms with special imaging equipment for complex procedures—and an experienced team who can help determine appropriate treatment measures and provide the highest standard of care before, during and after surgery.