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Surgery for Aortic Aneurysm and Dissection

An aneurysm is an enlarged portion of a weak area of an artery; an aortic aneurysm occurs in the aorta, the main blood vessel that carries blood away from the heart. Over time, blood flow can cause the weak area to bulge like a balloon. These balloon-like aneurysms can burst or rupture, causing serious internal bleeding and, if not treated, death. In your chest, near your heart, it is called a thoracic aneurysm; in your stomach area, it is referred to as an abdominal aneurysm.

A related condition is aortic dissection, which is most common in the chest area and occurs when the wall of the aorta tears, causing bleeding. Aortic aneurysm often precedes dissection, or the two may happen at the same time. Although the exact reasons for these conditions are not known, trauma, an unhealthy lifestyle, and high blood pressure are among the causes.

Many aortic aneurysms and dissections are found during screening for an unrelated condition. They can then be treated before they reach dangerous sizes, thereby preventing further adverse outcomes. The general rule is if an aneurysm is larger than 5 to 6 centimeters (2.3 inches), it should be considered for treatment. Aortic dissections vary in site and extent, and risk therefore does too.

If an aortic aneurysm or aortic dissection ruptures, it is a surgical emergency. The main symptom of both tends to be severe pain, either steady or intermittent, sometimes described as sharp, stabbing, or tearing, that may move to the arms or legs. Dissection can cause nausea, dizziness, fainting, and shortness of breath as well. Aortic aneurysm rupture can lead to stroke, which causes sudden weakness or numbness in a limb, slurred speech, or lack of vision and balance.

If you think you or someone you know is experiencing any of these conditions, call 9-1-1 immediately.

Diagnosis
Aortic aneurysm and aortic dissection are frequently discovered when screening for an unrelated problem. The tests we offer that often reveal aortic concerns include:

  • Computed tomography (CT) scan;
  • Magnetic resonance imaging (MRI);
  • Transesophageal echocardiogram (TEE); and
  • Abdominal ultrasound.

Treatment
Some aortic dissections and aneurysms may be treated with medication -- often antihypertensives to reduce blood pressure -- and/or careful monitoring, sometimes called watchful waiting. If your aortic condition requires surgery, however, our team, led by Allison J. McLarty, MD and Thomas V. Bilfinger, MD, can perform the latest minimally invasive techniques. Endovascular ("within the blood vessel") methods not only treat you effectively, but reduce recovery time as well as complications and risk of infection. They are especially valuable in the older, sicker patient. By threading catheters through small skin incisions in the groin area, we can insert a metal or plastic tube called a graft into the aorta where the dissection or aneurysm occurred. When necessary, we can remove the aneurysm section of the aorta and replace it with a Dacron tube that serves as a new conduit for blood flow from the heart during open surgery.