What Are Aortic Diseases?

• Atherosclerosis (hardening or deterioration of the vessel quality): Aneurysms can form as a result of atherosclerosis. As atherosclerosis progresses, artery walls thicken, become damaged, and lose their normal inner surfaces. The damaged part of the artery can bulge or balloon, resulting in an aneurysm.
• Aneurysms can also occur due to continuous high blood pressure inside the arteries.
• Trauma, such as chest impact during a car accident, can lead to the formation of an aneurysm.
• Certain medical conditions like Marfan syndrome, characterized by tall stature and long fingers, can lead to aneurysms. Individuals with Marfan syndrome may experience thinning of the blood vessel walls.
• In rare cases, untreated infections like syphilis can lead to aortic aneurysms.

Aortic aneurysm symptoms and signs depend on its type, location, whether it has ruptured, or its relationship with other structures in the body. Aneurysms can develop and grow over years without causing any complaints.

They slowly enlarge over the years and do not cause any symptoms until they rupture. Sometimes, during an examination, a pulsating mass can be noticed in the patient’s abdomen. If they cause symptoms, these may include deep, stabbing pain in the back or along the edges of the abdomen, a constant burning pain lasting for hours or days in the abdomen, and cooling or numbness in the feet.

Aneurysms in the abdominal region are referred to as Abdominal Aortic Aneurysms (AAA). If AAA ruptures, symptoms include sudden and severe pain in the lower abdomen or back, nausea and vomiting, sweating, dizziness, and an increased heart rate when standing up. Internal bleeding caused by a ruptured AAA can lead to shock in the patient.

Thoracic (chest) aortic aneurysms may not cause symptoms until they grow or rupture. The emerging complaints may include pain or coughing in the jaw, neck, back, or chest, hoarseness, or difficulty breathing.

Symptoms associated with peripheral aneurysms include a pulsating mass felt in the neck, arm, or leg, pain in the arm or leg, and exercise cramps.

Acute aortic dissection is the most common aortic condition requiring emergency surgery. Aortic dissection occurs when there is a tear between the layers of the aortic wall, allowing blood to enter a false lumen within the layers. It is most often observed in elderly individuals. Since the survival chances decrease significantly if the aorta ruptures, newly developed aortic dissection is an urgent and life-threatening condition.

 

This condition is typically classified into Type A (involving a tear in the ascending thoracic aorta) and Type B (involving a tear in the descending thoracic aorta). Type A dissections carry a high mortality risk of around 1% for every hour without surgery. In cases of Type B dissection, surgery is not required unless there is rupture or impaired circulation in the organs. Standard tube graft placement is employed in dissection surgery.

The decision regarding the need for surgery for an aneurysm is made by cardiovascular surgeons. If surgery is deemed necessary, the choice of surgical procedure is based on the location, size, and functionality of the aortic valve.

Surgical methods that can be chosen for the treatment of thoracic aortic aneurysms:

 

Repair of ascending aneurysm with tube graft placement:

If the aortic valve is normal, the aortic root is not enlarged, and the aneurysm is in the ascending aorta, the repair is done by placing a tube graft. The enlarged part of the ascending aorta is cut, and artificial tubes, known as Dacron or Gore-Tex, are placed in its position. These artificial tubes are durable for a lifetime.

 

Aneurysm repair preserving the aortic valve:

If possible, surgery is performed by preserving the aortic valve rather than replacing it. This procedure can be applied to patients with an aneurysmatic aortic root and aortic valve insufficiency but with normal-shaped aortic leaflets. The aortic valve and coronary arteries are reattached to the artificial vessel. Patients undergoing this type of operation are relieved from long-term use of blood thinners.

 

Composite aortic root replacement:

If patients require replacement of both the aortic root and the aortic valve, a composite aortic root replacement operation is performed. In this surgery, an artificial vessel with a pre-implanted artificial aortic valve is used to replace the aorta. Both mechanical and biological valves can be used in these operations.

 

Aortic arch surgery:

Aortic arch surgery is technically challenging. During this surgery, a branched graft is used to protect the brain, the body is cooled (hypothermic circulatory arrest), and a procedure called “antegrade cerebral perfusion” is used to send oxygen-rich blood to the brain. The use of these techniques reduces the risk of death and stroke.

 

Thoracoabdominal aneurysm repair:

Repairing aneurysms involving the thoracoabdominal aorta requires a complex and extensive surgical procedure. A potential complication of surgery is the disruption of blood supply to the spinal cord due to the exit of arteries supplying the spinal cord from this area. An anesthesia procedure is performed by an anesthetist to reduce this complication.

 

Stent graft placement (endovascular repair):

In some cases, and for aneurysms that do not involve the ascending aorta, there is a new repair method known as “stent graft repair.” It is a minimally invasive treatment for abdominal aneurysm repair. This type of stent graft placement can be performed in centers with sufficient equipment. This procedure can be performed if the patient’s aortic anatomy is suitable. If it is not suitable, standard open aortic surgery should be performed.

 

Repair of abdominal aortic aneurysm:

In the surgical treatment of abdominal aortic aneurysms, tube graft placement is performed. In some cases, if the iliac arteries are also aneurysmal, a pant leg graft is used.