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Aortic Aneurysms Surgery

Aortic Aneurysm Surgery at North Texas Surgical Specialists

An aortic aneurysm is a bulging, dilation, or ballooning in the wall of a blood vessel, usually an artery, that is due to weakness or degeneration that develops in a portion of the artery wall. Just like a balloon, the aneurysm enlarges, stretching the walls of the artery thinner, thereby compromising the artery wall’s ability to stretch any further. At this point, the aneurysm is at risk of rupturing and causing  potentially fatal bleeding, just as a balloon will pop when blown up too much.

Aneurysms can occur anywhere along or in the immediate vicinity of the aorta. They are classified into several groups according to their location:

  • Abdominal aortic aneurysms (AAAs) – Most aortic aneurysms (AAs) occur in the abdominal aorta. These are called abdominal aortic aneurysms (AAAs). Although most abdominal aortic aneurysms are asymptomatic at the time of diagnosis, the most common complication remains life-threatening rupture with hemorrhage.
  • Thoracic Aortic Aneurysm (TAA)  These occur in the thoracic aorta, the upper part of the aorta and are also subject to rupture.
    • TAAs are further subdivided subdivided into the following three groups:
      • Ascending aortic aneurysms
      • Aortic arch aneurysms (arteries that branch off the top of the aorta and form an arch)
      • Descending thoracic aneurysms, also called thoracoabdominal aneurysms (see below) 
  • Thoracoabdominal aneurysms (TAAAs) – Aneurysms that coexist in both segments of the aorta (thoracic and abdominal) are termed thoracoabdominal aneurysms (TAAAs).
  • Visceral Artery Aneurysms
    Aneurysms can also occur in the branches coming off the aorta which supply blood to the vital organs, such as the liver, spleen, kidneys and intestines. This type of aneurysm is classified as a visceral (organ) artery aneurysm.

Risk Factors

There are several risk factors for the development of aortic aneurysms including:

  • Atherosclerosis (“hardening of the arteries”)
  • Hypertension (high blood pressure) causes increased pressure on the weakened portion of the aorta leading to stretching and bulging of the artery wall over time and the development of an aneurysm.
  • Infection or inflammation
  • Smoking (greater than 100 cigarettes in a lifetime)
  • Age greater than 65 years old
  • Male gender (Men are approximately 6 times more likely to get an abdominal aortic aneurysm than women)
  • Inherited connective tissue disorders (Marfan syndrome, Ehlers-Danlos syndrome, collagen vascular diseases) are genetic defects in collagen, which is one of the main building blocks of artery walls, including the aorta
  • COPD (chronic obstructive pulmonary disease)
  • Patients with a 1st degree relative with an abdominal aortic aneurysm have a greater risk of developing an aneurysm themselves.

What are the symptoms of an aortic aneurysm?

Most aneurysms do not cause any symptoms until they burst. If they become symptomatic prior to bursting, though, the symptoms depend on the location of the aneurysm along the aorta:

Thoracic aortic aneurysm: An aortic aneurysm in your chest region can cause pain in your chest, upper back, neck, and jaw. You might also experience breathing difficulties and coughing.

Abdominal aortic aneurysm: An abdominal aortic aneurysm might result in lower back pain, groin pain, or abdominal pain. Your physician might notice a mass or lump while feeling your abdomen during a standard physical exam.

How is an aneurysm treated?

Our team an NTSS specializes in conservative aortic aneurysm management, focusing on non-invasive and minimally invasive approaches before moving on to surgical options.

Small aneurysms can be managed medically with blood pressure control and stress reduction. They are monitored regularly with an ultrasound every 6-12 months.

Larger aneurysms warrant closer follow-up and sometimes a CT with contrast (dye injected through the vein). If they enlarge beyond a certain diameter, enlarge too fast, or become symptomatic then our specialists can manage appropriately. Each aneurysm is unique and requires its own plan of repair.

Endovascular option:
This is the modern way of fixing aneurysms. It usually involves going through small cuts in the groin and placing a specialized stent that allows the blood to flow to the kidney and leg arteries without pressurizing the aneurysm.

Our specialists are well trained to use the most advanced stents available today. This includes the traditional stents used to fix simple aneurysms, as well as advanced devices to tackle special situations. Examples of these include:

  • Fenestrated endografts: These stents have special fenestrations (holes) in the graft material that correspond to the bowel and kidney vessels. This allows us to manage aneurysms with short necks that would have required open surgical repair in the past.
  • Polymer-based endografts: These devices use a special polymer resin to support the top of the endograft and seal when the neck of the aneurysm is short.
  • Iliac branch endografts: These are special endografts that help maintain flow to arteries supplying pelvic organs (which used to require a plug in the past causing problems to patients)

Open option:
If less invasive approaches are not effective or available in your case, the team might recommend open abdominal surgery or open chest surgery to repair your aorta with a tube-shaped synthetic graft. This is becoming less likely due to advancements in stent technology.

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