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Often an aortic aneurysm that has not caused symptoms may be found by chance during a routine physical exam or imaging test performed for another reason.
Accurate imaging is essential to the diagnosis and treatment of all types of aortic disease. Cardiovascular radiologist Diana Litmanovich, MD, conducts imaging studies of aortic aneurysm patients and works with other members of the Aortic Center team to diagnose aortic conditions and provide an in-depth view of patient anatomy to guide pre-operative evaluation.
Not all aortic aneurysms require surgical treatment. Depending on the size of the aneurysm and whether or not it is causing symptoms, some patients with an aortic aneurysm can have their condition managed medically, with the goal of slowing its growth and the risk of rupture.
Medical management involves:
a thorough evaluation
imaging exams performed over time to monitor aneurysm growth
the use of medications to reduce blood pressure, cholesterol and heart rate
counseling to reduce modifiable risk factors
Medical Director Dr. Brett Carroll, communicates and coordinate cares with Aortic Center surgeons and other medical or surgical specialists at BIDMC to ensure the best treatment for each individual.
Co-Director Dr. Marc Schermerhorn and other members of the Aortic Center surgical team are nationally recognized innovators in the development and use of minimally invasive endovascular procedures. Because of our expertise and experience, endovascular aneurysm repair (EVAR) is often the first choice for treatment for growing numbers of our patients, even those requiring complex repair who might not be candidates for endovascular treatment elsewhere.
Endovascular repair does not require large incisions and may be performed without general anesthesia. Other benefits include:
EVAR involves placing a device called a stent-graft in the damaged section(s) of the aorta via a catheter inserted through small incisions in the groin and/or arms. The stent-graft helps restore blood flow and prevent aneurysms from rupturing by acting as a support to take pressure off the wall of the aorta.
State-of-the-art imaging technology called Vessel Navigator is used to guide surgeons throughout endovascular procedures (LINK TO ARTICLE), providing a precision view of the patient’s blood vessels, and enabling complex aneurysm repairs. BIDMC helped develop and was one of the first medical centers in the world to use this technology, and today the Aortic Center uses Vessel Navigator to guide nearly all endovascular procedures.
The Aortic Center is also leaders in percutaneous (incision-less) endovascular repair, a technique we helped to pioneer and have perfected. Today, 90% of patients undergoing endovascular treatment in the Aortic Center are treated with the percutaneous approach, compared to 20% nationally. Percutaneous repair uses punctures in the skin, rather than small incisions, to position the stent-graft into the aneurysm. BIDMC research shows that this percutaneous approach reduces complications, operating room time, and length of hospital stay.
We have extensive experience repairing aneurysms with a wide range of stent-grafts. These include individually customized stent-grafts, branched stent-grafts and fenestrated stent-grafts, which have special openings called fenestrations that are customized to the patient’s unique anatomy, allowing blood to flow from the aorta to vital organs. Our experience and good outcomes in the use of the newest stent-grafts allow us to offer an endovascular approach to greater numbers of patients.
Some aortic aneurysms or dissections, particularly those located close to the heart, must be treated with open surgery. Our team of highly experienced cardiac surgeons has performed thousands of open surgeries to repair complex aortic aneurysms at the aortic root (where the aorta connects to the heart), the ascending aorta and the aortic arch, from which the vessels that provide blood to the head and arms extend. We provide:
valve-sparing aortic root repair
aortic valve and root replacement
repair of the ascending aorta
the Bentall procedure — replaces the aortic valve, aortic root and ascending aorta with a composite graft
the elephant trunk procedure — replaces the aortic arch and leaves a section of graft in the descending aorta that can be used to repair aneurysms lower in the aorta
For thoracoabdominal aortic aneurysms that span both the chest and abdomen, our cardiac surgeons and vascular/endovascular surgeons work together in the operating room.
When appropriate, the Aortic Center offers patients a hybrid surgical approach in which our cardiac and vascular/endovascular surgeons work side-by-side in one of our three state-of-the-art hybrid operating rooms to treat aortic aneurysm or dissection using a combination of open surgical and endovascular approaches. This hybrid approach reduces operating room time and time under general anesthesia, and is less invasive than open surgery — all of which reduce risk for patients.