UAB Comprehensive Aortic Program

The aorta is the main blood vessel that carries blood from your heart to the rest of your body. It has three layers that provide strength and flexibility.

An aneurysm occurs when a weakening in the wall of an artery allows the vessel to bulge out like a balloon.

Common risk factors include:

• Smoking
• High blood pressure (hypertension)
• High cholesterol
• Older age
• Conditions that weaken blood vessels (such as connective tissue disorders)

Aneurysms can occur in any blood vessel in the body, including arteries and veins. Arteries are the blood vessels that carry oxygen-rich blood from the heart to the rest of the body, and the most common arterial aneurysms are in the brain or aorta. The aorta is the largest artery in the body, arising directly from the heart and providing blood flow through branches to the entire body.

When an aneurysm develops in the aorta, it is called an aortic aneurysm. Because of a risk of rupture leading to internal bleeding and death, it is important to identify and treat aortic aneurysms at the appropriate time. With early detection and proper follow-up, most aneurysms can be repaired when the size of the aneurysm justifies the risk of repair.

Depending on the location, the cause, and the patient’s overall health state, an aneurysm can be repaired with either traditional “open” surgery or with minimally invasive “endovascular” methods, using smaller incisions and working through the inside of the blood vessels.

During an open aortic aneurysm repair, the weakened area of the aorta is replaced with an artificial tube made of a cloth-like material called Dacron, which is made of woven polyester. Depending on their location, open aneurysm repairs may be performed by either a vascular or cardiovascular surgeon. In some cases, vascular surgeons and cardiac surgeons work together to repair certain types of aortic aneurysms.

Endovascular aneurysm repairs depend heavily on the anatomy of the blood vessels and the cause of the aneurysm. Compared to open surgery, the minimally invasive procedure normally results in less pain and a faster recovery for the patient, but it cannot be used in all cases.

Aneurysms can occur in any part of the aorta and are characterized by their anatomic location. The aorta is a continuous tube that begins at the heart and ends in the pelvis. It is divided into the thoracic and abdominal sections by the diaphragm where the aorta enters the abdomen from the chest. The thoracic aorta arises from the heart as the ascending aorta, then becomes the transverse aorta or aortic “arch” where the blood vessels to the brain and arms arise, then the descending thoracic aorta as it descends through the chest. The abdominal aorta begins as the aorta passes through the diaphragm.

Aortic aneurysms vary greatly, and the timing and type of repair used often depend on where the aneurysm begins and ends. The various types are discussed below.

Types of aneurysms

Ascending aortic aneurysms

Ascending aortic aneurysms develop in the section of the aorta immediately above the heart. Repairing this type of aneurysm typically requires open surgery, which is most commonly performed by a cardiac surgeon. In some highly selected cases, these aneurysms can be treated with endovascular therapy.

Aortic arch aneurysms

Aneurysms in the aortic arch traditionally have been repaired with open methods, but newer endovascular methods are currently in development that allow for minimally invasive treatment of some of these aneurysms. Additionally, “hybrid” open and endovascular procedures are sometimes used to allow for a less invasive option than a traditional open operation. These procedures may require the involvement of both vascular and cardiac surgeons.

Descending thoracic aneurysms

Aneurysms in the descending thoracic aorta are most commonly treated with endovascular methods, but arterial anatomy and cause of the aneurysm may prevent a minimally invasive treatment from being used. Endovascular treatment of these aneurysms is often referred to as “TEVAR,” which stands for thoracic endovascular aortic repair.

Thoracoabdominal aortic aneurysms

Aneurysms that extend from the thoracic aorta through the diaphragm into the abdominal aorta are called thoracoabdominal aneurysms. These are often the most complex type of aortic aneurysm and carry the highest risks associated with repair. Depending on arterial anatomy and cause of the aneurysm, thoracoabdominal aneurysms may be treated with endovascular, open, or hybrid techniques.

Abdominal aortic aneurysms

Abdominal aortic aneurysms, often referred to as AAA, are the most common type of aortic aneurysm and develop in the section of the aorta below the diaphragm and within the abdomen. These aneurysms are most often treated with endovascular methods, but sometimes they must be treated with open surgery for various reasons, which your surgeon can discuss with you in detail. Endovascular treatment of AAA is often referred to as “EVAR,” which stands for endovascular AAA repair.

The aorta is the main vessel that carries blood from your heart to the rest of your body, and it is made up of 3 layers. An aortic dissection is a tear in the wall of the aorta that occurs between the inner and middle of those 3 layers. As the tear extends along the wall of the aorta, it can cause blood to flow in between the layers of the aorta and “dissect” the layers apart, thus the name.

An aortic dissection can reduce the blood flow to your brain, arms, kidneys, liver, bowels, spinal cord, and legs, depending on how it impacts the flow of blood to the branches of the aorta. The dissection can also cause the aorta to rupture, which may lead to life-threatening bleeding. An aortic dissection is a serious medical condition that occurs in about 2 out of every 10,000 people. It can develop in anyone but most often is seen in men between the ages of 40 and 70.

The cause of aortic dissection usually involves multiple factors. Some common risks include:

• Smoking
• Uncontrolled hypertension (high blood pressure)
• Advanced age
• Hypercholesterolemia
• Bicuspid aortic valve
• Cocaine or methamphetamine use
• Narrowing (coarctation) of the aorta
• Connective tissue disorders, such as Marfan, Loeys-Dietz, or Ehlers-Danlos syndromes, among other rare genetic disorders
• Complications from open heart surgery or endovascular procedures
• Hypertension associated with pregnancy
• Aneurysm associated with conditions such as arteritis and syphilis