Aortic aneurysm and dissection

Ist der Durchmesser der Hauptschlagader krankhaft erweitert, spricht man von einem Aortenaneurysma. Reißt die Aorta ein, spricht man von einer Dissektion.

The aorta is the main artery in the human body, and arises from the heart. After leaving the heart, it passes upwards towards the head (ascending aorta), before bending over (aortic arch) and proceeding down towards the lower body (descending aorta) past the spinal column and through the chest and abdominal cavity. Its job is to distribute blood to the various parts of the human body. If the diameter of the aorta increases abnormally in size, then this is known as an aortic aneurysm. A dissection occurs when there is a tear in the wall of the Aorta.

Aortic Aneurysm

If the diameter of the aorta increases in size and its wall becomes thinner, then this is known as an aortic aneurysm. There is an increased risk of a tear or rupture in the aorta, which can be a serious consequence of an aortic aneurysm. Early surgery to insert a synthetic substitute can protect against a life-threatening tear or rupture. Surgical or interventional treatment of an aortic aneurysm or dissection will depend on the location and size of the aneurysm.

Surgical or interventional treatment of an aortic aneurysm or dissection will depend on the location and size of the aneurysm. If there is an aneurysm in the ascending aorta or aortic arch, a synthetic vascular graft must often be used to replace the damaged area. Aortic aneurysms in the chest or abdominal cavity, on the other hand, are often treated with the help of a coated metal mesh tube (stent). The decision about which procedure to use can be made in consultation with the doctor handling your case.

On the day of your admission to a general ward, you will be questioned in detail, your paperwork will be examined, and any outstanding tests will be conducted, e.g. blood tests, computed tomography (CT), X-rays or ultrasound examinations. Once all of your paperwork and tests are complete, you will discuss the operation you require with the surgeon and the anesthetist. The operation will take place the next day under general anesthesia. The aorta is typically accessed by opening the breastbone. You will then be connected to the heart-lung machine, and your heart stopped. The heart-lung machine distributes blood around your body while the aorta is being replaced. Then the damaged aorta is removed and a vascular graft sutured into place. The heart-lung machine is then disconnected and the breastbone and skin carefully closed. When the anesthetic wears off, you will wake up in the intensive care ward. For the next 24 hours you will be monitored either in intensive care or in our intermediate care ward, before being transferred to the general ward. You will normally spend between seven and ten days in hospital.

Aortic dissection

A tear or rupture in the aorta is a life-threatening emergency which requires immediate surgical or interventional treatment. A distinction is made depending on the locality of the tear; Type A dissections involve the ascending aorta, and Type B the descending aorta. A Type A dissection requires immediate surgery. The procedure used is aortic replacement (cf. Aortic aneurysm). As soon as diagnosis is complete, usually by means of a CT scan, an operation is performed without further delay. A Type B dissection can also be treated by implanting a stent.

How safe is aortic replacement?

Aortic replacement for an aortic aneurysm is regarded today as being among the safest operations that can be carried out on the heart and surrounding vessels. The risks associated with such operations depend upon the size and location of the aneurysm, your age and physical condition, whether you are suffering from any other health problems, and the urgency of the operation (whether it is an emergency or a planned procedure). The surgeon will discuss all the risks that apply in your specific case as part of a detailed consultation.