Aortic Diseases & DisordersAortic Aneurysms
An aneurysm is a weakening or ballooning of a blood vessel. This process may occur in any artery in the body. Aneurysms may also occur in any part of the aorta, including the root, the arch, the ascending and the descending aorta. Aneurysms may be thought of as a balloon. If one blows up a balloon, it is difficult at first. There is a fair amount of opposing strength. Think of this strength as the condition of a normal aorta. Think now about the point where that strength is overcome. It becomes quite easy to distend the balloon with more air. Consider that this is the situation of an aneurysmal aorta. As we all have experienced, eventually one more puff of air will break the balloon. All balloons rupture at different points, but the risk seems to increase with both the absolute amount and/or speed of air entering.
This principle holds true for the aorta as well. Most people can tolerate aneurysms of up to 5cm, without any real increased risk of aortic problems. At about 5cm, however, there is an increased risk of tearing. To go back to the balloon example, this is the size where it gets easy to change the size.
Aneurysm and Aortic Dissection
An aortic aneurysm greater than 5cm increases the risk of a dissection, or tear in the wall of the aorta. An aortic dissection is a life threatening emergency and can lead to a full rupture. Learn more about aortic dissection.
Aneurysm and Aortic Valve Regurgitation
In addition to the risk of death associated with aortic aneurysm and dissection, an aneurysm can dilate the base of the aortic valve, causing aortic valve regurgitation. With regurgitation, the valve fails to adequately seal, allowing the reverse flow of blood and resulting in an inadequate blood flow to the body. As this process ensues, the heart may enlarge and ultimately result in congestive heart failure.
About Surgery for Aortic Aneurysm or Dissection
Elective Surgery for Aortic Aneurysm or Dissection
While both aneurysms and dissections are potentially life threatening, they can be effectively treated when caught in time. Aortic surgery may be elective (scheduled) or performed on an emergency basis. Elective surgery is performed to prevent complications of aortic disease such as aortic valve incompetence, aortic rupture, and aortic dissection. Elective procedures include replacement of the aortic root, reconstruction of the aortic arch, and replacement of a portion or the entire thoracic (and possibly thoracoabdominal) aorta.
Emergency Surgery for Aortic Aneurysm or Dissection
Emergency aortic surgery is performed to repair life-threatening complications of aortic disease. Emergency procedures include repair of aortic dissection, replacement of the aortic valve in acute valve incompetence, repair of traumatic aortic transection, and replacement of a ruptured aneurysm.
It is important to note that there is a vast difference between elective and emergency aortic surgery. If a patient has a known aneurysm and surgery is advised, the decision to delay or forego surgery increases the risk for rupture or dissection, both of which are serious emergencies with far poorer outcomes than elective surgery. Moreover, emergency procedures are commonly performed at the hospital that is closest in proximity to where the patient developed symptoms. Many of these hospitals may not offer the same level of care and results as an Aortic Center of Excellence.