Conditions of the Aorta

The surgeons at the Division of Vascular and Endovascular Surgery offer a full range of minimally invasive endovascular procedures and open surgery options to patients suffering from thoracic and abdominal aortic aneurysms as well as aortic dissection.

Procedures for Aortic Aneurysm

Aneurysm

The aorta is the body's largest artery, and carries oxygenated blood away from the heart to all parts of the body. When a weak area of the aorta expands or bulges, this is called an aneurysm. An aneurysm poses a very serious health risk, because it can burst (rupture), causing severe internal bleeding, which can rapidly lead to death. The location of an aneurysm can vary and is named for the affected section of the aorta (thoracic means in the chest; thoraco-abdominal means between chest and abdomen; abdominal is in the abdomen).

Abdominal and Thoracic Endovascular Stent Graft (abdominal and thoracic aneurysm)

MINIMALLY INVASIVE

When is it used? Endovascular stent grafting is used for an aneurysm occurring in the thoracic and abdominal section of the aorta.

What happens? Guided through the blood vessel system by a catheter, a slender tube made of metal and fabric called a stent graft is placed permanently at the site of the aneurysm. It seals tightly with the artery above and below the aneurysm, shielding the dangerously weak section from the high-pressure flow of blood. Blood flow now passes through the aorta without pushing on the bulge, which helps keep the aneurysm from bursting.

Usually the patient can return home within one day, and return to normal activities in three to four weeks.

OPEN SURGERY is a secondary option if an endovascular procedure is not possible.

Fenestrated Endograft Procedure

MINIMALLY INVASIVE

Endograft

When is it used? This technique is used to repair an aortic aneurysm, when the aneurysm located in a very specific spot–around branching vessels leading to the head, neck, intestines and kidneys.

The location of the aneurysm makes a procedure challenging since many major arteries branch out from the aorta. While the weakened section of the aorta must be shielded from the high-pressure flow of blood, the blood flow within other branching arteries must continue. The solution is to protect the weak section with a special type of graft tube with holes (fenestrations). These holes line up perfectly with the arteries branching from the aorta. This achieves both goals–preserving their blood flow, while walling off the weak section of the aorta.

What happens? Guided through the blood vessel system by a catheter, a slender tube made of metal and fabric called a graft is placed at the site of the aneurysm. It seals tightly with the artery above and below the aneurysm, shielding the dangerously weak section from pressure from the blood flow. Blood now passes through the aorta without pushing on the bulge, which helps keep the aneurysm from bursting.

OPEN SURGERY is a secondary option if an endovascular procedure is not possible.

Open Surgical Repair of Thoracic, Thoraco-Abdominal or Abdominal Aneurysms

OPEN SURGERY

When is it needed? While minimally invasive techniques are preferred when treating an aneurysm, some patients may not qualify for an endovascular procedure and will require open surgery.

What happens? Patients will receive general anesthesia for the operation. During this procedure a surgeon makes an incision at the site of the aneurysm, exposing the affected artery. For Abdominal Aortic Aneurysm (AAA), for example, your surgeon will work through your abdominal wall. If your aneurysm is in your thorax as in the case of a Thoracic Abdominal Aneurysm (TAA), your surgeon will operate in your chest. Once the aneurysm site is exposed, the surgeon will clamp the artery above the aneurysm to stop blood from flowing through the area. The wall of the weakened artery is opened to remove any clotted blood and plaque deposits.

The decision to completely remove an aneurysm will depend on the location of the aneurysm. The surgeon may insert a graft that is the same size and shape as your healthy artery and sew it to the healthy artery just above where the aneurysm begins and below the end of the aneurysm. An alternative option would be to attach a graft to the artery wall to reduce its size and strengthen it. Patients will stay in the hospital for about 7 to 10 days after the surgery.

Procedures for Aortic Dissection

Endovascular Stent Graft (for aortic dissection)

MINIMALLY INVASIVE

Endo AAA Repair

When is it used? The endovascular stent graft technique is also used to repair this extremely serious condition, in which the three layers of the aortic wall separate (dissect) from one another. The condition starts with a tear in the innermost layer, or lining, of the bodyss largest blood vessel, the aorta. The tear permits blood–under pressure–to surge into and pound against the outermost layer, or arterial wall. Over time, the constant pressured flow can push the aorta to burst, an event that is usually fatal.

What happens? Through a small incision in the groin, a catheter is guided through the blood vessel system to the site of the problem. There, a synthetic stent graft is threaded to the location of the dissection and left permanently at the affected site. The stent graft does several things: It provides a channel for blood to flow freely, it repairs the leakage in the artery and the stent props open the aorta, preventing blood pressure from causing it to burst.

This procedure usually involves a hospital stay of 1-2 days, and a recovery period of a couple of weeks.

Open Surgical Repair for Aortic Dissection

OPEN SURGERY

When is it used? Traditional open cardiovascular surgery is rarely performed for aortic dissection. However, if the aortic dissection occurs in the ascending aorta, which branches from the heart to the upper body, open surgical repair is the option for all patients.

What happens? After the chest is opened, the surgeon removes the dissected portion of the aorta. This portion is replaced by a synthetic graft (tube) that is sewn into place, through which blood flows freely from the aorta to the rest of the arterial system. This involves a hospital stay of a week or more, and recovery can take 6-8 weeks.

For more information or to make an appointment with a vascular surgeon at Mount Sinai Beth Israel, click here to fill out an appointment scheduling form. A staff member will get back to you within 48 hours to schedule an appointment.

For An Appointment Call

Thomas R. Bernik, MD
Endovascular and Vascular Surgery
212.844.5555

Robert J. Grossi, MD
Vascular Surgery
212.844.5559

Gary A. Gwertzman, MD
Vascular Surgery and Wound Care
718.677.0109

Stephen P. Haveson, MD
Vascular Surgery and Wound Care
212.844.1330

Jennifer Svahn, MD
Vascular Surgery (Venous Disease)
212.420.5648

Vascular Labs
212.844.5555