Tests & Procedures > Vascular Services > Abdominal and Thoracic Aortic Repair/Replacement

Abdominal and Thoracic Aortic Repair/Replacement

The surgeons at PinnacleHealth Cardiovascular Institute are expert at both traditional and minimally invasive aortic repair and replacement.

Aortic aneurysm repair is a procedure used to treat an aneurysm (abnormal enlargement) of the aorta. Aneurysms can develop anywhere along the aorta which runs from your heart through the center of your chest and abdomen. Aortic aneurysms usually occur in the abdominal area and are called abdominal aortic aneurysms (AAA).  When they occur in the upper part of the aorta, they are called thoracic aortic aneurysms

What is an aortic aneurysm?

An aortic aneurysm 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 vessel's normal diameter (width). The aorta is the body's main supplier of blood and a ruptured aortic aneurysm can cause life-threatening bleeding.
 
Depending on the size and rate at which your aortic aneurysm is growing, treatment may vary from watchful waiting to emergency surgery.

What are the risk factors for an aortic aneurysm?

It is not certain what causes an aortic aneurysm but risk factors include :
  • Age
  • Tobacco use
  • Atherosclerosis
  • Being male
  • Family history
Specialized tests that will confirm if you have an aortic aneurysm include:
  • Abdominal ultrasound.
  • Computerized tomography (CT) scan.
  • Magnetic resonance imaging (MRI

Types of Abdominal Aneurysm Repair

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). The options for treatment of your aneurysm will depend on a variety of factors, including location of the aneurysm, your age, kidney function and other conditions that may increase your risk of surgery or endovascular repair.
  • Abdominal aortic aneurysm open repair. Open repair 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. The aneurysm will be repaired using a 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 and requires recovery for several days in the hospital.
  • Endovascular aneurysm repair (EVAR) - This is a minimally-invasive procedure performed in an operating room, radiology department, or a catheterization laboratory under general anesthesia, epidural or spinal anesthesia. Your doctor 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. The stent helps to hold the graft in place. The stent-graft is inserted into the aorta in a collapsed position and once in place, the stent-graft will be expanded (in a spring-like fashion), attaching to the wall of the aorta to support it. The aneurysm will eventually shrink down onto the stent-graft.
Recovery time for people who have endovascular surgery is shorter than for people who have open-abdominal surgery. However, follow-up appointments are more frequent because endovascular grafts can leak. Follow-up ultrasounds are generally done every six months for the first year, and then once a year after that. Long-term survival rates are similar for both endovascular surgery and open surgery.

Reasons For The Procedures

It’s important to discuss with your doctor the risks associated with both procedures; however, he or she will like recommend surgery for one or more of the following reasons:

  • To prevent the risk of rupture
  • To relieve symptoms and restore a good blood flow
  • Size of aneurysm greater than 5 centimeters in diameter (about two inches)
  • Growth rate of aneurysm of more than 0.5 centimeter (about 0.2 inch) over one year
  • When risk of rupture outweighs the risk of surgery
  • Emergency life-threatening hemorrhage (uncontrolled bleeding)