Main Artery (Aorta)

Aortic Aneurysm/Aortic Dissection

Aor­tic Aneu­rysm

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.