- Areas of Expertise
Aortic Diseases and Treatments
At Sentara Vascular Specialists, we provide the full range of diagnostic and treatment services for aortic diseases, including abdominal aortic aneurysms, thoracic aortic aneurysms, and aortic dissection. These include the latest in medical imaging and open surgical and minimally invasive treatments. When appropriate, we recommend minimally invasive treatments, which use smaller incisions and result in less trauma, blood loss, and pain; fewer complications; a shorter hospital stay; and faster recovery times. We take a team approach to your care, considering your unique needs and preferences to develop a treatment plan that is right for you. At Sentara Vascular Specialists, we believe that you are at the center of your care team, and we work with you so that you fully understand your condition and the treatment recommendations, and feel confident about your care.
What Are Aortic Disorders?
The aorta is the largest blood vessel and it is responsible for transporting blood from the heart to arteries that branch from it and lead to the rest of the body. The aorta has three sections, the ascending aorta, which runs up from the heart, the thoracic aorta, which runs through your chest, and the abdominal aorta, which runs through your midsection before it branches into the iliac arteries. Although aortic disorders are on the whole uncommon, two of the most common aortic diseases are aortic aneurysms and aortic dissection.
An aneurysm is a weakened, bulging area of an artery. Abdominal aortic aneurysms (AAAs) and thoracic aneurysms (TAAs) occur in different parts of the aorta. The most significant danger with an aortic aneurysm is that it will burst, or rupture. The aorta has three layers, an inner layer, a middle layer, and an outer layer. The pressure of the blood traveling through the aneurysm causes the inner lining to tear, and as blood flows into the middle layer, it causes the inner and middle layers to separate (dissect). The condition is most dangerous if the blood flow causes the outer layer of the aorta to rupture. Because of the amount of blood loss that occurs, aortic rupture and aortic dissection can be life-threatening situations that require quick treatment.
Treatments for AAA and TAA
The treatment recommendation your doctor will make depends on the size of the aneurysm and how fast or slowly it is growing. For smaller, slower-growing aneurysms, your doctor may recommend medication to control blood pressure as well as closely monitoring the aneurysm's size. With this type of monitoring, called watchful waiting, you will undergo regularly scheduled medical imaging tests, such as ultrasound or magnetic resonance angiography, to track the aneurysm's size. If and when the aneurysm grows large enough to require treatment, your doctor may recommend surgical or minimally invasive treatment of the aneurysm.
Surgical Aneurysm Repair
Surgical repair of an aortic aneurysm is an open procedure performed under general anesthesia. It involves removing or bypassing the section of the aorta that has been affected by the aneurysm. After gaining access to the aorta, the surgeon removes the weakened portion of the aorta, and then attaches a synthetic tube (called a graft) above and below the aneurysm.
Minimally Invasive Aneurysm Repair
To avoid the large incision and extended recovery time involved in surgical aneurysm repair, surgeons developed endovascular aneurysm repair, which is minimally invasive. In endovascular repair, the surgeon makes a small incision in arteries located in your groin, and then advances a catheter (a thin, flexible tube) through the blood vessels to the location of the aneurysm. The catheter holds a synthetic tube called an endograft, which the surgeon attaches to the inner artery wall. The endograft forms a kind of tunnel through which blood flows, relieving the pressure on the weakened portion of the aorta.
Treatments for Aortic Dissection
Treatment for aortic dissection includes controlling and repairing the tear, if necessary. Your doctor's treatment recommendations will depend on the type of dissection and its location, but can include medication or surgery. Surgery is necessary if the dissection has taken place near where the aorta leaves the heart (called a type A dissection). During surgery, the surgeon removes the dissected portion of the aorta and connects a synthetic tube, called a graft, to take the place of the dissected portion of the aorta. If the dissection has taken place in the descending aorta (type B dissection), your doctor may recommend managing it with medications used to control high blood pressure as well as monitoring the condition. If the dissection worsens, your doctor may recommend surgery.