Options for Patients with Aortic Aneurysms

An aortic aneurysm is an abnormal bulge due to weakening of the wall of the aorta, the body’s main artery, which runs from the heart to the abdomen. These aneurysms can tear or rupture, causing a life-threatening emergency.

Dr. Robert Lawson

For many years, aortic aneurysms were treated exclusively with open surgery. However, patients are increasingly offered endovascular procedures, in which stent grafts are deployed to the aneurysm site via catheter. The catheter is inserted through the groin. Benefits of endovascular aortic repair (EVAR) include shorter procedural times, reduced hospital stays and faster recoveries.

“I started my practice at the dawn of the endovascular era in 2001, and since then the technology for minimally invasive repair of aortic aneurysms has advanced several fold,” said Pauley vascular surgeon, Dr. Robert Larson. “Endovascular repair is the standard for most patients, and new devices are on the horizon that will allow even more patients to choose this option.”

According to Dr. Vigneshwar Kasirajan, one of the most common of these types of surgeries performed at VCU Health is for an aortic dissection. This life-threatening condition occurs when an injury allows blood to flow between the layers of the aortic wall, forcing them apart. This injury, which requires emergency surgery, can be handled through open surgery, sometimes with a cardiovascular bypass machine, or endovascularly.

“Our access to the latest technology, endovascular devices and surgical techniques allows us to provide the widest possible array of treatment options.” — Dr. Robert Lawson

While many patients can be treated via catheterization, some aortic aneurysm patients still require traditional—usually open-heart—surgery. This can include patients with a thoracic aneurysm who may also have heart valve disease, disease of the aorta next to the heart or extensive aorta disease, leading into the abdomen or other major arteries.

“For those with thoracic aneurysms that are extensive or more complex, heart surgery is sometimes performed at the same time as an open-chest aneurysm repair,” said Kasirajan. “In addition, thoracic surgeons may work alongside vascular surgeons to complete a complex procedure involving the entire aorta or peripheral blood vessels.”

Other patients, such as those with arch and descending thoracic aortic aneurysms, can be managed in the hybrid operating room with endovascular interventions. In these cases, a cardiac surgeon may take part in the procedures or stand by scrubbed in, should surgical intervention be required.

“I predict sooner rather than later that most of the aortic diseases will be managed in the hybrid operating room with minimally invasive techniques,” said Kasirajan.

In 2016, VCU Health physicians performed over 100 open aneurysm repairs and about 100 endovascular repairs of various types. Many innovative procedures are conducted. For instance, VCU Medical Center is also the only hospital in the Richmond area to use fenestrated aortic endografts to repair aneurysms involving the renal arteries, said Larson.

“VCU Health offers expertise in all aspects of complex aortic surgery from both the CT surgery and vascular surgery side, with a team approach to surgical management. We also have world-class preoperative care with dedicated cardiac anesthesiologists and intensive care specialists,” said Larson. “Our access to the latest technology, endovascular devices and surgical techniques allows us to provide the widest possible array of treatment options.”

Visit http://www.pauleyheart.vcu.edu/clinical/aortic/index5.html, or watch a video at https://www.youtube.com/watch?v=mdogNvxKH3k.

Did you know…
VCU Health offers genetic testing for patients with a family history of a collagen vascular disease such as Marfan Syndrome, a condition that affects the connective tissue of the body and causes damage to the heart, aorta and other parts of the body.

Aortic Practice to Debut at Stony Point
Pauley has recently opened a large, multidisciplinary outpatient clinic on VCU Health’s Stony Point Campus. Almost all of Pauley’s cardiologists and cardiothoracic and vascular surgeons will be offering office hours at the new Stony Point site. Patients can have echocardiograms and vascular testing performed there, with stress tests available in the future.

The surgeons are new to Stony Point; in cardiology, “we’re probably quadrupling our capacity there. We’re also getting a dedicated space, which will allow us to grow,” said Dr. Zachary Gertz, who is serving as the medical director. “Cardiology is outgrowing the space downtown.”

In addition, “multidisciplinary care is great for patients. You don’t just get one point of view, you get the input of the whole heart team.” Other benefits, he said, include “easy parking and better patient access.”

For more information, please visit vcuhealth.org/stonypoint