Vascular and Endovascular Surgery

Aortic Aneurysm and Dissection

Thoracic aneurysms (TAA)

A thoracic aortic aneurysm, also called TAA, is a bulging, weakened area in the wall of the aorta (the largest artery in the body), resulting in an abnormal widening or ballooning greater than 50 percent of the normal diameter (width). The aorta extends upward from the top of the left ventricle of the heart in the chest area (ascending thoracic aorta), then curves like a candy cane (aortic arch) downward through the chest area (descending thoracic aorta) into the abdomen (abdominal aorta). The aorta delivers oxygenated blood pumped from the heart to the rest of the body.

The aorta is under constant pressure from blood being ejected from the heart. With each heartbeat, the walls of the aorta expand and spring back, exerting continual pressure or stress on the already weakened aneurysm wall. Therefore, there is a potential for rupture (bursting) or dissection (separation of the layers of the thoracic aortic wall), which may cause life-threatening hemorrhage (uncontrolled bleeding) and, potentially, death.

Once formed, an aneurysm will gradually increase in size and there will be a progressive weakening of the aneurysm wall. Treatment for a thoracic aneurysm may include surgical repair or removal of the aneurysm to prevent rupture.

Treatment for thoracic aortic aneurysm

Specific treatment will be determined by your physician based on: your age, overall health, medical history, extent of the disease and other factors. Treatment options may include:

• Routine MRI or CT - to monitor the size and rate of growth of the aneurysm
• Controlling or Modifying Risk Factors - steps such as quitting smoking, controlling blood sugar if diabetic, losing weight if overweight or obese, and controlling dietary fat intake may help to control the progression of the aneurysm
• Medication - to control factors such as hyperlipidemia (elevated levels of fats in the blood) and/or high blood pressure
• Thoracic Aortic Aneurysm Open Repair  - The type of surgical repair of a thoracic aortic aneurysm will depend on several factors: the location of the aneurysm, the type of aneurysm, and the patient's tolerance for the procedure. For an ascending or aortic arch aneurysm, a large incision may be made through the breastbone (median sternotomy). 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 (thoracotomy). These approaches allow the surgeon to visualize the aorta directly to repair the aneurysm.
• Endovascular Aneurysm Repair (EVAR) - EVAR is a procedure which requires only small incisions in the groin, along with the use of x-ray guidance and specially-designed instruments, to repair the aneurysm by inserting a tube, called a stent-graft, inside the aorta. At this time, the only thoracic aneurysms repaired by means of EVAR are descending thoracic aneurysms.

Thoracic Aortic Dissection (TAD)

An aortic dissection begins with a tear in the inner layer of the aortic wall, usually in the ascending or descending thoracic aorta. The aortic wall is made up of three layers of tissue. When a tear occurs in the innermost layer of the aortic wall, blood is then channeled into the wall of the aorta separating the layers of tissues. This generates great pressure in the aortic wall with a potential to rupture (burst). Aortic dissection can be a life-threatening emergency.

The cause of aortic dissection is still under investigation. However, there are several risk factors associated with aortic dissection, such as: hypertension (high blood pressure), connective tissue disorders, cystic medial disease and aortitis.

The most commonly reported symptom of an acute aortic dissection is severe, constant chest and/or upper back pain, sometimes described as "ripping" or "tearing." The pain may be "migratory," moving from one place to another, according to the direction and extent of the dissection.

Abdominal Aortic Aneurysm Repair

Abdominal aortic aneurysm (AAA) repair is a procedure used to treat an aneurysm (abnormal enlargement) of the abdominal aorta. Repair of an abdominal aortic aneurysm may be performed surgically through an open incision or in a minimally-invasive procedure called endovascular aneurysm repair (EVAR).

There are two approaches to abdominal aortic aneurysm repair. The standard surgical procedure for AAA repair is called the open repair. A newer procedure is the endovascular aneurysm repair (EVAR).

• Abdominal Aortic Aneurysm Open Repair - Open repair of an abdominal aortic aneurysm involves an incision of the abdomen to directly visualize the aortic aneurysm. The procedure is performed in an operating room under general anesthesia. The surgeon will make an incision in the abdomen either lengthwise from below the breastbone to just below the navel or across the abdomen and down the center.
   
  Once the abdomen is opened, the aneurysm will be repaired by the use of a long cylinder-like tube called a graft. Grafts are made of various materials, such as Dacron (textile polyester synthetic graft) or polytetrafluoroethylene (PTFE, a non-textile synthetic graft). The graft is sutured to the aorta connecting one end of the aorta at the site of the aneurysm to the other end of the aorta. Open repair remains the standard procedure for an abdominal aortic aneurysm repair.
• Endovascular Aneurysm Repair (EVAR) - EVAR is a minimally-invasive (without a large abdominal incision) procedure performed to repair an abdominal aortic aneurysm. EVAR may be performed in an operating room, radiology department, or a catheterization laboratory. The physician may use general anesthesia or regional anesthesia (epidural or spinal anesthesia).
   
  The physician will make a small incision in each groin to visualize the femoral arteries in each leg. With the use of special endovascular instruments, along with x-ray images for guidance, a stent-graft will be inserted through the femoral artery and advanced up into the aorta to the site of the aneurysm. A stent-graft is a long cylinder-like tube made of a thin metal framework (stent), while the graft portion is made of various materials such as Dacron or polytetrafluoroethylene (PTFE) and may cover the stent. The stent helps to hold the graft in place. The stent-graft is inserted into the aorta in a collapsed position and placed at the aneurysm site. Once in place, the stent-graft will be expanded (in a spring-like fashion), attaching to the wall of the aorta to support the wall of the aorta. The aneurysm will eventually shrink down onto the stent-graft.

Your physician will determine which surgical intervention is most appropriate, either open repair or EVAR. 

To schedule an appointment with a Cooper University Hospital physician at an office near you, call 1-800-8-COOPER (800-826-6737) to speak with a member of our physician referral and information service.

Our Offices

Camden
Three Cooper Plaza, Suite 403
Camden, New Jersey 08103
Appointments (856) 342-3113
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Marlton
127 Church Road, Suite 400
Marlton, New Jersey 08053
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Voorhees
6017 Main Street
Voorhees, New Jersey 08043
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Washington Township
Bunker Hill Plaza, Suite 202
Sewell, New Jersey 08080
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Our Physicians

• Babak Abai, M.D.
• James B. Alexander, M.D.
• Jeffrey P. Carpenter, M.D.
• Joseph V. Lombardi, M.D.