Main Artery (Aorta)
Aortic Aneurysm/Aortic Dissection
The vasodilation of the main artery is called an aortic aneurysm.
The aorta is the largest blood vessel in the human body. With high pressure, it distributes oxygen-rich blood from the heart throughout the body. Various factors such as smoking, hereditary predisposition, an age of >60 years and sex (more often in men) can lead to the forming of an aneurysm. In the majority of case, it is the abdominal aorta, and less often the thoracic aorta, that is affected.
This aneurysm is often referred to as a “bomb in the belly” because it can burst without any warning signs or symptoms (aortic rupture). Mortality from aortic rupture is very high at >90%. In the majority of cases, an abdominal aortic aneurysm is discovered by chance during routine check-ups, usually through an ultrasound examination. Aneurysms of the thoracic aorta (thoracic aortic aneurysm) often show an enlarged shadow in an X‑ray of the lungs.
Abdominal aortic aneurysms with a size of >4 cm in the ultrasound scan should additionally be checked with computerized tomography. If a thoracic aortic aneurysm is suspected, computerized tomography must be performed as a general rule. Abdominal aortic aneurysms with a maximum diameter of 5 cm and aneurysms of the thoracic aorta starting at a size of 5.5 cm are treated surgically.
Type B Aortic Dissection
An aortic dissection causes tearing of the wall layers in the main artery due to very high blood pressure. Patients report sudden, unbearable pain in the back and between the shoulder blades. Aortic dissections are the most common emergency condition of the main artery and primarily affect the thoracic aorta. Type A aortic dissection affects the descending thoracic aorta. Acute mortality in this form of aortic dissection is >10%.
Several surgical procedures are available for the treatment of aortic aneurysm and aortic dissection:
- Open surgical replacement of the abdominal aorta
Through the sewing in of an artificial prosthesis, the abdominal aortic aneurysm is completely shut off. Operative access is via an incision in the abdomen (laparotomy). This classic operation from the 1950s is the standard (gold standard) in the treatment of the abdominal aorta. It is mainly carried out on younger patients <60 years without relevant secondary diseases.
- Endovascular Therapy of the Abdominal Aorta by means of Stent Prosthesis (EVAR)
The introduction of a covered wire mesh (stent graft) separates the blood flow, and thus the blood pressure, from the aneurysm. This requires only minimal incisions in the groin area for operative access. This is more conservative than the open surgical procedure, but can not be carried out with every patient. The possibility of endovascular therapy depends primarily on the type of aneurysm.
- Endovascular Therapy of the Thoracic Aorta by means of Stent Prosthesis (TEVAR)
When treating aneurysms of the thoracic aorta, it is almost only endovascular therapy that is used. As with an abdominal aortic aneurysm, a stent prosthesis is introduced through small accesses in the groin area and unfolded in the body.
- Endovascular Therapy using a Fenestrated Stent Graft (FEVAR)
In about 10% of cases of abdominal aortic expansion, the renal vessels are affected. This requires endovascular treatment with a custom-made stent prosthesis made individually for the patient. The operation can be carried out conservatively via small accesses in the groin area.
- Endovascular Therapy of Type B Aortic Dissection by means of Stent Prosthesis (TEVAR)
Under certain circumstances, patients with type B aortic dissection must undergo thoracic endovascular aortic repair (TEVAR) therapy to avoid life-threatening sequelae.
- Hybrid Operation for Aortic Aneurysm and Type B Aortic Dissection
By combining open surgical therapy with an endovascular procedure, the size and strain of the surgical procedure can be reduced in individual cases. Under special circumstances, this procedure can be used for abdominal and thoracic aortic vasodilations and aortic dissections.