Heart and Vascular Center
Aortic DiseaseThe aorta, the largest blood vessel in the body, is the central channel from the heart to the body. The aorta may need repair following a traumatic injury (such as a car crash), the discovery of an aneurysm (a bulge in the aorta wall), the development of a blockage or a sudden tear in the inner lining (aortic dissection).
The aorta may be repaired using traditional open surgery or through a minimally invasive technique that uses a stent graft. Repairing the aorta using surgery vs. a minimally invasive approach depends on the location of an aneurysm or the extent of an injury to the aorta. The repair method used is determined on a case-by-case basis.
Heart and vascular specialists at Froedtert & The Medical College of Wisconsin are highly skilled in performing both methods of aorta repair. The Heart and Vascular Center performs a higher percentage of aortic surgeries than any hospital in Wisconsin.
Surgical Repair of the AortaSurgical repair of a thoracic aortic problem involves making a large incision in the chest. A surgeon then clamps off the aorta, removes the diseased or injured part of the aorta, and sews in a plastic graft to act as a bridge for the blood flow.
To protect the brain and central nervous system during certain types of open aortic repair, hypothermic circulatory arrest (HCA) may be done. This involves lowering the body’s temperature, which reduces the body’s need for blood flow and oxygen, allowing the surgeon to work on certain parts of the aorta that would otherwise be impossible. The brain can be further protected in these procedures by a technique called selective brain perfusion.
Minimally Invasive (Catheter-based) Repair of Aortic AneurysmAn aneurysm in the part of the aorta above the diaphragm is a thoracic aortic aneurysm (TAA); below the diaphragm, it is called an abdominal aortic aneurysm (AAA). Medical College of Wisconsin physicians are highly skilled in repairing both types of aneurysms using a minimally invasive catheter approach and stent grafts (a tube-like device). This method eliminates the need to repair the aneurysm in an open chest procedure.
In 2006, Froedtert & The Medical College of Wisconsin were the first in the region to perform thoracic endovascular (inside the vessel) artery repair (TEVAR) to repair TAAs. TEVAR is a minimally invasive catheter technique in which a stent graft is placed within the aneurysm through a blood vessel in the leg. This less invasive method involves using a catheter to place a graft within the aneurysm to redirect blood flow and stop direct pressure from being exerted on the weak aortic wall. An incision is made in the skin at the groin through which a catheter is passed into the femoral artery and directed to the aortic aneurysm. Through the catheter, the physician passes a stent graft that is compressed within the catheter. After the stent graft is advanced to the aneurysm, it is opened, creating new “walls” in the blood vessel through which blood flows. The physician uses imaging to guide the catheter and stent graft inside the patient’s artery. TEVAR is performed using a comprehensive team approach, including vascular surgeons, cardiac surgeons and interventional radiologists.
For certain patients, stent grafts have greatly simplified the repair procedure, preventing the need for major surgery. The stents can also be used in patients who have other diseases that would make open surgery risky. The results of using stents are comparable to open-chest surgery, but patients generally experience less pain, fewer complications and a greatly reduced recovery time. In certain cases, the stent graft can also be used for traumatic injuries and tears of the thoracic aorta.
Last Review Date: June 18, 2008 Online Editor(s): Richard Petre |