Aortic Disease

The aorta is the largest artery in the body. Via its multiple branches the aorta allows delivery of oxygenated blood to all organ systems and extremities. Problems affecting the aorta are generally serious in nature, and include aortic aneurysms, aortic dissection and aortic narrowing / occlusion.

The aorta is a large caliber artery that serves as the primary outflow vessel from the heart. The aorta courses through the chest into the abdomen, where it divides into the right and left iliac arteries (that take blood to both right and left leg respectively).

Throughout its course in the chest and abdomen multiple branches allow oxygenated blood to be delivered to all critical organs throughout the body including the brain, kidneys, intestines, and spinal cord. In addition branches supply blood to the extremities and to the musculoskeletal system.

A variety of pathologic conditions can affect the aorta. The most common pathologic condition affecting the aorta include aneurysmal disease. In this disease process weakening of the wall of the aorta results in localized (or diffuse) areas of dilatation of the aortic wall. The most common location to get aneurysmal degeneration of the aorta is in its abdominal segment. This condition is known as abdominal aortic aneurysm (“AAA”). Areas of aneurysmal degeneration are prone to diameter-dependent risk of rupture. If aortic aneurysm rupture occurs it is a life-threatening event.

Another pathologic condition that can affect the aorta is “aortic dissection”. In this disease process a defect in the wall of the aorta creates an abnormal pathway that allows an abnormal channel of blood to flow within the wall of the aorta. Instead of a large single lumen in the aorta seems a “double-barrel” configuration. This passage of blood into this abnormal channel can create a variety of serious blood-flow abnormalities that can be life or limb threatening.

High-grade narrowing (or blockage) of the abdominal aorta interferes with the delivery of oxygenated blood to the lower extremities. In this circumstance patients typically have pain in their bilateral lower extremities with minimal exertion (or pain at rest).

Aortic Disease Symptoms

Patients with abdominal aortic aneurysm are typically asymptomatic, although it is possible to have abdominal pain associated with the aneurysm.

Although some patients with aortic dissection are asymptomatic, most patients with acute aortic dissection report central back pain. The location and severity of back pain can vary significantly between patients.

Patients with a high-grade narrowing or occlusion of their abdominal aorta, usually have symptoms that reflect diminished circulation to the legs, and typically have flank pain either at rest (or with minimal exertion).

Aortic Disease Treatment

Treatment options for aortic aneurysmal disease are determined by the location, size and shape of the aneurysm. If the aortic aneurysm reaches a size where intervention is felt necessary most patients are candidates for stent-graft insertion. Stent-graft devices are inserted into the aorta via access sites in the groin. These devices eliminate pressurization of the aneurysm sac, and thereby decrease propensity for aneurysm rupture.

Treatment options for aortic dissection includes medical therapies to control blood pressure, and a variety of stent-graft devices that can re-direct blood flow into the true-lumen, reducing blood flow and pressure in the false-lumen channel.

Treatment options for aortic narrowing or occlusion include stents and stent-grafts, and open surgical bypass procedures.

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