Aortic Disease (Dissection and Aneurysm)

The aorta, the body's largest artery, delivers blood from the heart to the rest of the body. When disease is present, the aorta can tear (dissect) or dilate to form an abnormal widening or ballooning called an aneurysm. These conditions may lead to rupture of the aorta, which may be life threatening. Treating acute aortic disease requires the proper integration of surgical, interventional (stents), and medical techniques to achieve the best outcome possible for patients. MedStar Heart & Vascular Institute physicians are expertly trained, and have experience managing the most difficult cases of aortic dissection and aneurysm. We treat our patients with

• A multidisciplinary approach with cardiologists, cardiovascular surgeons, and vascular surgeons
• Surgical, endovascular, and medical management treatments, decided upon by a combined team on a case by case basis
• Endovascular (minimally-invasive procedure that reduces recovery times and reduces the rates of infection) techniques with excellent outcomes

Aortic Aneurysm

Aortic aneurysms occur when the aorta wall, thinned and weakened from atherosclerosis, swells and balloons. The following types exist:

• Thoracic aortic aneurysms are located in the upper aorta, in the chest, and are usually repaired with stent-grafts.
• Abdominal aortic aneurysms (AAA) occur in the abdominal section of the aorta and often enlarge over time. Most do not cause symptoms and may be discovered during a routine examination or as part of a test performed for another condition. Occasionally, patients may feel abdominal or back pain. AAA in the thirteenth leading cause of death in the United States and is more common in males. Patients over the age of 65 who are prior or current smokers are particularly at risk.
• Peripheral aneurysms refer to those aneurysms that affect arteries other than the aorta. These are most commonly located in the legs. Most patients have no symptoms. Peripheral aneurysms generally do not rupture but may embolize (send) a clot from within the aneurysms to the arteries downstream. Occasionally, this is a limb-threatening condition.

Aortic Dissection

Aortic dissection is a condition in which there is bleeding into and along the wall of the aorta (the major artery from the heart). There are two types of aortic dissections, depending on where the tear begins and ends:

• Type A: This type is more common and more dangerous. In these cases, the tear occurs in the ascending aorta where it exits the heart and extends down through the descending aorta. The tear may extend into the abdomen. Type A cases usually require emergency surgery.
• Type B: This type involves a tear in the descending aorta only, which may also extend into the abdomen. Depending on where the tear develops, our doctors may recommend medication or surgery.

Risk Factors

• Chronic high blood pressure
• Genetic conditions such as Marfan syndrome
• Chest trauma
• Aortic aneurysm

Symptoms

• Back or chest pain
• Changes in thinking ability, confusion, disorientation
• Clammy skin, sweating
• Cough
• Decreased movement or sensation, any location
• Dizziness, fainting, nausea, and vomiting
• Dry skin/mouth, thirst
• Excessive yawning
• High blood pressure
• Intense anxiety, anguish
• Pallor (paleness)
• Rapid pulse or weak/absent pulse
• Shortness of breath

Diagnostic Tools

• Angiography
• Cardiovascular MRI
• CT Scan
• X-ray
• Echocardiogram

Treatment Options

• Medications, such as antihypertensives, drugs to lower blood pressure or cardiac medications such as beta-blockers
• Surgery, including:
  • Coronary Artery Bypass Graft (CABG)
  • Heart valve surgery (aortic valve replacement)
  • Repair or replacement of the section of the aorta

Learn more about aortic dissection treatment.