The aorta is the largest artery in the body. It connects the heart with the rest of the body and is responsible for moving blood throughout all of the systems, organs and tissues. If the walls of the aorta become stretched or weakened, the result may be an aortic aneurysm. Aortic aneurysms are at risk of rupture, which is a life-threatening emergency.
Damage to the aorta needs to be addressed with surgery, either with a minimally invasive procedure or traditional open surgery.
Aortic aneurysm is a bulging of tissue through the damaged aortic wall. An aneurysm can develop when a portion of the aortic wall weakens and then expands. The aorta has two parts: the thoracic aorta is the portion that runs through the chest, and the abdominal aorta is the portion that runs through the abdomen. Aortic aneurysm can develop in either or both parts of the aorta.
There are three types of aortic aneurysm:
This type occurs in the section of the aorta that runs through the abdomen. Abdominal aortic aneurysms can grow slowly over time and sometimes go undetected because they may not cause any symptoms. If the aneurysm becomes large it can show symptoms that may include severe, throbbing pain in the stomach or back.
This type occurs in the section of the aorta that runs through the chest. Like the abdominal aortic aneurysm, a TAA can grow slowly without causing symptoms. A large TAA may cause symptoms including:
This type of aneurysm occurs in sections of the aorta that span across both the abdomen and the chest.
This is a rare, a life-threatening condition that mostly affects males in their 60s and 70s.
Aortic dissection occurs when layers of the aorta split apart. When this happens, blood does not flow properly through the cardiovascular system, and blood supply is reduced to the rest of the body. This “misdirection” of blood can cause a heart attack or stroke, or it can damage organs in the body.
Symptoms appear suddenly and can include:
Aortic repair can be performed as endovascular (minimally invasive) surgery or open-heart surgery, depending on the severity of the damage.
The TEVAR procedure repairs a thoracic aortic aneurysm or aortic dissection. This minimally invasive option reinforces the weakened portion of the aorta to reduce the risk of rupture.
Endovascular abdominal aneurysm repair (EVAR) is a minimally invasive procedure to repair an abdominal aortic aneurysm (AAA). Surgeons fasten a repair device on the aortic wall to strengthen the damaged area.
During these complex surgical procedures, the surgeon makes a large incision in the chest and/or abdomen, removes the weakened section of the aorta and replaces it with a fabric graft. The graft restores strength to the weakened aorta and allows blood to pass through it without causing a bulge.
This complex procedure repairs an aneurysm in the portion of the aorta located in the abdomen.
This complex procedure repairs an aneurysm in the portion of the aorta located in the chest.
This is the most complex of aortic repair procedures. TAAA repairs an aneurysm located in both the chest and abdominal portions of the aorta.
Treatment for aortic aneurysm is potentially lifesaving, because aneurysms can lead to rupture or dissection. Immediate treatment for aortic dissection is essential to survival. Repairing the damaged aortic wall strengthens the aorta and reduces the risk of future problems.
Although some patients are not candidates for endovascular procedures, minimally invasive therapies typically have fewer risks and faster recovery times than traditional open surgery procedures. Patients usually benefit from higher procedure success rates and can often resume normal activities in about a week.
Patients can expect different surgical details, depending on which type of procedure is used. Endovascular procedures are less complex than open surgery.
The minimally invasive TEVAR and EVAR procedures involve making small, dime-sized incisions in the groin and threading catheter tubes through the femoral artery (located in the thigh) and into the aorta.
A fabric covered metal stent is inserted and guided through the artery to the affected area. The stent is then inserted into to the weakened portion of the aorta, and it will remain there indefinitely. This will relieve pressure on the aorta to prevent rupture.
Sometimes surgeons use local anesthesia, and patients remain awake during the procedure. For some patients, general anesthesia is needed due to the complexity of the procedure.
Open-heart surgery to repair aortic aneurysm or aortic dissection is a lengthy, complex procedure. Patients are put on a heart-lung machine to maintain breathing, heartbeat and the flow of blood during the surgical procedure.
Surgeons make a long incision in the chest or stomach, depending on the location of the aneurysm or dissection. The diseased portion of the aorta is removed, and a fabric graft is positioned in its place. This reinforces the aortic wall to allow for proper blood flow.
Patients may experience the following risks or side effects with endovascular procedures:
Patients may experience the following risks or side effects with open surgery:
Each patient’s recovery is different and depends on the type of procedure performed. With an endovascular procedure, patients can expect to stay in the hospital for one or two days, followed by limited activities at home for a couple of weeks. Long-term medication to prevent blood clots or to lower blood pressure or cholesterol may be needed.
Open surgery requires a longer recovery period. Most patients remain in the intensive care unit (ICU) until they are stable, and then they are moved to a regular hospital room for about a week. Patients may need breathing support and supplemental feeding during this time. When patients are discharged to go home, a full recovery can take weeks or months.
The Aortic Center of Excellence is one of the world's largest aortic surgical practices and is a major center for device development research. Physicians affiliated with the center were the first in the world to perform robotic reconstructive aortic surgery and are world leaders in the reconstruction of aortic aneurysms.
Memorial Hermann’s Larry D. Johnson Heart & Vascular Institute is committed to providing cutting-edge cardiovascular care. Specialists are paving the way in the field of complex aortic surgery, providing access to new technology, techniques and research.
If you’d like a referral to a heart and vascular specialist or want more information about our services, please fill out the form below or call us at (713) 219-3519. For other inquiries, such as obtaining medical records, imaging reports or test results, please call (713) 222-CARE (2273).