Aneurysm Repairs

An aneurysm is a blood-filled, balloon-like bulge in a weakened artery caused by the pressure from blood flow. Aortic aneurysms occur in the aorta, the main artery of the heart. There are three types, depending on the location in the body:

• Abdominal aortic aneurysms occur in the section of the aorta that passes through the abdomen.
• Thoracic aortic aneurysms occur in the chest area. They may involve the aortic root, ascending aorta, aortic arch or descending aorta.
• Thoracoabdominal aortic aneurysms occur in the aorta as it passes through both the abdomen and chest.

How will my surgeon repair the aneurysms?

Surgery is often required to treat aneurysms. Those occurring in the ascending aorta may need to be repaired immediately. If left untreated, aneurysms could burst, a potentially fatal situation, or cause aortic dissections, or tears.

Your doctor has a few procedures available to repair an aneurysm, depending on its severity and location:

1. Endovascular aneurysm repair (EVAR): An endovascular treatment takes place inside your arteries. EVAR is a minimally invasive procedure using long, thin tubes called catheters that your surgeon threads through your blood vessels.
          
   Your vascular surgeon can perform this endovascular procedure if your aneurysm is located in the abdominal aorta. If not, your cardiac surgeon may be able to use an intravascular approach or an open approach.
            
   First, your doctor may administer general anesthesia or a local spinal anesthesia called an epidural. The doctor then makes a small incision in your groin area to insert the catheter. Once the catheter is in place, the doctor uses an X-ray to help guide a graft (a long, synthetic tube) through the catheter and inside the aneurysm.
             
   Think of the aorta as a large hose. The graft is like a straw threaded through the aneurysm, almost like a bridge, creating the original shape of the aorta. After the surgery, blood flows through the straw and the aneurysm will eventually shrink around it.
            
2. Open aortic aneurysm repair: This procedure takes place in an operating room and involves general anesthesia, so you are asleep. Open surgery is necessary when there is bleeding inside your body from an aneurysm, or when you at risk for an aneurysm bursting.
           
   Once your cardiac surgeon locates the aneurysm, he or she then attaches a graft (a long, synthetic tube) to the aorta, reconnecting the parts above and below the aneurysm. Then your surgeon removes the clamps, allowing blood to flow again.
          
3. Complex arch replacement and the elephant trunk: Patients with extensive aortic aneurysms involving the artery around and including the aortic arch may require this more complex surgical procedure. The aortic arch is where the ascending aorta bends, curving downward into the descending aorta.
            
   This procedure takes place in an operating room and involves general anesthesia, so you are asleep. Your cardiac surgeon replaces the aortic valve, ascending aorta, the aortic arch and the descending aorta using an "elephant trunk" graft, a synthetic tube that curves around the arch and hangs in the descending aorta. It is called an elephant trunk graft because of its shape.

Why choose us for aneurysm repair?

Our cardiac surgeons and vascular specialists operate in the most advanced surgical suite in the Washington, D.C., area. Our hybrid suite is a state-of-the-art operating room with the most sophisticated imaging equipment, allowing for faster diagnosis and treatment of complicated diseases. We perform 3-D imaging procedures and ultrasounds in the same place as treatments and surgeries.

In the hybrid suites, our surgeons can perform open surgery and endovascular surgery, incorporating the latest technology. In complicated cases, our cardiac surgeons can treat more than one problem at the same time. For example, they can treat an aneurysm or aortic dissection and then move on to repair or replace any affected valves.

Learn more about our hybrid suites.

The MedStar Heart Institute is the only place to go for heart surgery. Schedule an appointment or second opinion with one of our top surgeons or call 202-877-DOCS. Or order a free information kit about our cardiac surgery program.