Thoracic and Abdominal Aortic Aneurysms and Dissections
Abdominal Aortic Aneurysm
When a blood vessel bulges, it means the walls of the vessel have weakened and stretched, like a balloon. If the walls become too thin, the force of the blood causes the vessel to burst and serious internal bleeding occurs.
The most common type of aneurysms is abdominal aortic aneurysms (AAA), but our vascular surgeons treat thoracic aneurysms, as well. The aorta is the main blood vessel that carries blood from the heart to the rest of the body; it extends from the chest (thoracic) to the abdomen before branching out into the iliac arteries that carry blood to the legs and lower part of the body.
Most patients with aneurysms have no symptoms, but some may feel pain in their stomach, back, or chest, or experience a throbbing sensation in their abdomen. Aneurysms are usually diagnosed during tests like ultrasounds or CTs for unrelated problems.
When an aneurysm begins to bulge, Abington Memorial vascular surgeons may engage in a period of “watchful waiting,” monitoring the scale of the aneurysm and prescribing medications or other treatments before initiating surgical repair. Medical care can involve medications to control levels of plaque buildup (since this accumulation in the vessel can weaken the artery walls), decreasing risk factors through smoking cessation, losing weight, controlling high blood pressure and adopting a low-fat diet.
As an aneurysm grows larger, the chances increase that it will rupture. Then, surgeons use grafts—synthetic tubes—inserted into the aorta to keep it from bursting.
Grafts have a main tube and two smaller, lower legs that extend into the iliac arteries, which feed the femoral arteries in the thighs. The grafts are placed through endovascular techniques or open surgery.
Endovascular Aneurysm Repair
Also called EVAR, this minimally invasive procedure involves making two small incisions (in the groin) to reach your femoral arteries. The surgeon threads a thin catheter into each artery, and maneuvers the three-pronged graft into the damaged aorta. These grafts consist of a self expanding metal skeleton covered with a synthetic material.
Positioned within the aorta and the iliac arteries below it, the grafts are then released from their sheaths, opening and filling with blood. When both of the legs of the graft are connected to the main body, the graft seals off the aneurysm. The self-expanding stents hold the graft in place.
Surgeons then remove the catheters and close up the incisions with just a few stitches. Patients may be hospitalized up to three days but often just overnight, with full recovery in approximately two to four weeks.
Open aortic repair involves making an incision in the abdomen and gently moving aside certain organs to reach the damaged aorta. Blank Center surgeons open the aneurysm and remove any blood clots that may have formed. Next, they sew the graft to the aorta, wrap the wall of the aorta around the graft, and stitch the entire wall back together. Sutures or staples keep the incision site closed.
Following open surgery, patients may be hospitalized five or more days. Recovery takes up to three months.
To refer a patient to The Blank Vascular Center, please call 215-887-5934.