The aorta may need repair following a traumatic injury (such as a car crash), or for an aneurysm, a blockage or a sudden tear (dissection) in the aorta’s inner lining.
The aorta may be repaired using traditional open surgery or through a minimally invasive endovascular technique. The treatment approach depends on the location of an aneurysm or the extent of injury to the aorta, and is determined on an individual basis.
Our heart and vascular specialists are highly skilled in performing all types of aorta repair. Among those treatments performed are:
- Endovascular aneurysm repair (EVAR) (minimally invasive)
- Thoracic endovascular aneurysm repair (TEVAR) (minimally invasive)
- Open surgical aneurysm repair
- Vascular and interventional radiology
- Emergency care
- Vascular surgery
Other procedures such as angioplasty, atherectomy and stenting may also be used to help treat aortic disease. See our complete list of treatments for heart and vascular diseases.
Endovascular Aneurysm Repair
Minimally invasive procedures such as endovascular aneurysm repair (EVAR), also called "endografting" or stent-grafts, generally result in less pain, fewer short-term complications and faster recovery than open surgery. Froedtert & MCW specialists are highly skilled in endovascular grafting procedures.
During EVAR, physicians make small incisions in the groin area. Guided by x-ray imaging and using special endovascular techniques, physicians advance the stent-graft through a catheter to the location of the aneurysm. The synthetic graft is custom-sized for each patient based on measurements previously collected from a CT scan.
The graft is released from inside the aorta and it expands to line the wall of the aorta. The stent-graft acts as an interior “sleeve,” allowing blood to safely flow through a weak area, and acts as a reinforcement for the weakened wall of the aneurysm. It reduces the direct pressure exerted on the weak aortic wall.
Thoracic Endovascular Aneurysm Repair
The Froedtert & MCW team was the first in the region to perform TEVAR, a minimally invasive procedure used to repair a thoracic aortic aneurysm (TAA) from inside the aorta, nearly 20 years ago. This procedure can also be used to repair the more complex thoracoabdominal aortic aneurysms.
Minimally Invasive Procedure Means Faster Recovery
The long-term results of thoracic aortic endografting are comparable to open-chest surgery, but the procedure eliminates the need to cut through the chest to repair the aorta. Thus, patients experience less pain, substantially fewer complications and much faster recovery.
TEVAR uses a covered sleeve, or stent-graft, to channel blood through an abnormal area of the aorta. The stent-graft is custom-sized for each patient and acts as a reinforcement from the inside of the weakened aortic wall.
During the TEVAR procedure, physicians make small incisions in the groin area. A catheter is guided to the aneurysm in the lower part of the thoracic aorta. Guided by x-ray imaging, physicians advance the stent-graft through the catheter to the location of the aneurysm. The synthetic graft is released from inside the aorta and it expands to line the wall of the aorta.
The stent-graft acts as an interior “sleeve,” allowing blood to safely flow through a weak area. It stops direct pressure from being exerted on the weak aortic wall. In cases of a torn aorta, such as after a motor vehicle accident, this procedure can be life-saving by covering the torn aortic wall and stopping further leakage.
The TEVAR procedure is performed by a specialized, multidisciplinary team of vascular surgeons, cardiac surgeons, and vascular and interventional radiologists. In certain cases, the stent-graft can also be used to treat traumatic injuries and tears of the thoracic aorta.
Open Surgical Aneurysm Repair
Open surgical aneurysm repair is performed in an operating room under general anesthesia. This traditional surgical approach involves making a large incision to reach the aorta. A surgeon clamps off the aorta, removes the diseased or injured part of the aorta, and sews in a fabric graft to act as a bridge for the blood flow.
Grafts are made of various materials, such as Dacron (textile polyester synthetic graft) or polytetrafluoroethylene (PTFE, a non-textile synthetic graft). The graft connects one end of the aorta at the site of the aneurysm to the other end of the aorta.
To protect the brain and central nervous system during certain types of open aortic surgery, hypothermic circulatory arrest (HCA) may be done for aneurysms that extend into the chest cavity. 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. These techniques are not required for aneurysms limited to the abdomen.