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Aortic Aneurysm Repair

If you or a loved one has been diagnosed with an aortic aneurysm, you’ll be glad to know that the cardiac surgery team at Northwest Regional Heart & Vascular has extensive expertise in successfully managing this condition.

Working closely with specialists in vascular surgery and interventional cardiology, our cardiac surgeons have performed hundreds of aneurysm repair procedures. It’s a level of experience that translates into excellent patient outcomes.

What is an aortic aneurysm?

An aortic aneurysm is a balloon-like bulge in the aorta, the large blood vessel that carries oxygen-rich blood from the heart to other parts of the body.

The aorta is shaped like a candy cane, with the short stem of the curve extending upward from the top of the heart (ascending thoracic aorta), then curving (aortic arch) downward through the chest area (descending thoracic aorta) into the abdomen (abdominal aorta). The aortic root is the section of the aorta closest to and attached to the heart; it consists of the aortic valve and the openings for the coronary arteries.

The aorta is under constant pressure from blood pumping from the heart. With each heartbeat, the walls of the aorta expand and contract, which exerts continual stress on an already-weakened aneurysm wall. As a result, there’s a potential for rupture (bursting) or dissection (separation of the layers of the thoracic aortic wall), which may cause life-threatening hemorrhage (uncontrolled bleeding).

There are two basic types of aortic aneuryms:

  • Thoracic aortic aneurysms (TAAs) occur along the portion of the aorta above the diaphragm (in the chest). This part of the aorta is made up of the aortic root, ascending aorta, aortic arch and descending thoracic aorta
  • Abdominal aortic aneurysms (AAAs) occur along the portion of the aorta that passes through the abdomen. These are far more common that thoracic aortic aneurysms, comprising up to 75% of aortic aneurysms, and are most often seen in men aged 40 to 70.

A thoracoabdominal aneurysm is a thoracic aortic aneurysm that extends continuously from the chest down to the abdominal area.

How aortic aneurysms are treated

How an aortic aneurysm is treated depends on its size, how fast it’s growing, its location, and the patient’s age and medical condition. Treatment may include:

  • Watchful waiting – For a small aneurysm or one that doesn’t cause symptoms, your doctor may recommend “watchful waiting.” This usually includes a CT or MRI scan every six months to closely monitor the aneurysm to see if it is growing or changing in any way.
  • Controlling risk factors – Steps such as quitting smoking, controlling blood sugar if you have diabetes, losing weight if you are overweight or obese, and controlling dietary fat intake may help to control progression of an aneurysm
  • Medical management – Medication may be used to control high blood pressure and high cholesterol (elevated levels of fat in the blood)
  • Endovascular stent graft repair – Many aneurysms can be treated with a minimally invasive approach called endovascular aneurysm repair (EVAR). An incision is made in the skin at the groin, and a catheter (thin, hollow tube) is threaded under x-ray guidance into the femoral artery to the aortic aneurysm. The doctor passes a compressed stent graft (a tiny, synthetic tube) through the catheter to the aneurysm site where the graft opened, creating new walls in the blood vessel through which blood flows.
  • Open surgical repair – For an ascending or aortic arch aneurysm, a large incision may be made through the breastbone. If an ascending aneurysm involves damage to the aortic valve of the heart, the valve may be repaired or replaced during the procedure. For a descending aneurysm, a large incision may extend from the back under the shoulder blade around the side of the rib cage to just under the breast.

Aortic root aneurysms are usually associated with leaking (insufficiency) of the aortic valve, which may require aortic valve replacement surgery in addition to aneurysm repair.

What treatment is right for me?

Each patient is unique, so the specific treatment that’s right for you depends on:

  • Your age, overall health and medical history
  • The size of your aneurysm
  • Symptoms you are having
  • Your tolerance for specific medications, procedures or therapies
  • Expectations for the course of the disease
  • Your personal preferences

Your doctor will discuss all the options with you and together you’ll decide on the most appropriate course of treatment.

Would you like to learn more about Aortic Aneurysm surgery in Portland? Please call us to schedule a consultation: (503) 261-4430.