If our doctors find a dangerous aneurysm in time, they can save your life with urgent aortic repair. For cases that are less urgent, but still troubling, we work with you to find the best treatment plan, whether that is careful monitoring, medication or a procedure that reinforces the aorta.
At the MedStar Heart & Vascular Institute, our world-renowned team offers the approaches you need for successful aortic care:
- Open Surgery
- Complex Repairs: Doctors around the region often refer patients to us.
- Minimally Invasive Endovascular Repair: Other programs use stent-grafts in the descending aorta, but we also place them in the ascending aorta.
- Hybrid Repairs Combining Surgery and Endovascular Techniques: We take this specialized approach more than any other heart and vascular program in the D.C. area.
Complex Aortic Aneurysms
While our team members provide top care for all types of aneurysms, they offer particular expertise for challenging cases. Our expertise with complex procedures leads many outside doctors to refer these patients to us — sometimes from more than a hundred miles away.
Complex cases can involve aneurysms that:
- Run across both the chest and abdomen (thoracoabdominal) and can interfere with blood vessels branching off the aorta
- Involve the aortic root, ascending aorta and/or aortic arch
- Involve other areas of the body and require a careful watch over blood supply
- Require multiple steps to fix
Aneurysms: Surveillance and Medical Therapy
Smaller aneurysms that do not cause pain may not need treatment. Instead, your doctor may recommend that you avoid heavy lifting, intense exercise and emotional stress and come in for regular monitoring.
Other aneurysm may pose somewhat greater risk but are manageable with medications that:
- Lower blood pressure
- Relax blood vessels
- Reduce the potential for rupturing
Traditional Aneurysm Surgery
Surgical repair is often the best treatment for aneurysms that are causing symptoms or have grown larger, generally 2 inches across or greater. There are two categories of surgery, though our doctors perform both similarly:
- Emergency Surgery: The aneurysm has already ruptured, or could soon, as indicated by symptoms like abdominal, chest or back pain.
- Elective Surgery: While there is more time to plan, the aneurysm’s size, rate of growth or interference with blood flow makes a repair necessary.
Aneurysm Surgery: Steps
Traditional aneurysm surgery replaces the damaged aorta and takes out at least part of the bulge, though complete removal is often unnecessary. Our doctors perform several steps:
- Some aneurysm repairs require cardiopulmonary bypass. Our surgical team uses a heart-lung machine to slow the heart and access the aorta, while still providing blood and oxygen to the brain and body. The body is cooled so it consumes less oxygen. Bypass is needed for:
- Aneurysms in the aortic root and ascending aorta
- Aneurysms in the aortic arch, unless a hybrid approach is taken (learn more about hybrid aneurysm repair)
- Some aneurysms that traverse the chest and abdomen (thoracoabdominal aortic aneurysms)
Other aneurysms do not require this step — the enlarged section is simply clamped while maintaining the most critical blood flow.
- After anesthesia, surgeons make an incision above the aneurysm and open the aorta.
- At least part of the aneurysm is removed and a long-lasting synthetic graft is placed to reinforce the damaged aorta.
- Bypass is ended, if it was needed. Otherwise, the clamps are removed and incision is closed.
- Hospital recovery typically takes 7 to 10 days.
Endovascular Aneurysm Repair
We also offer an alternative to surgery — a minimally invasive approach called thoracic endovascular aortic repair (TEVAR or EVAR) that uses a metallic scaffold and a synthetic fabric (stent-graft) to reinforce the aorta and avoid a rupture. While an endovascular approach is not appropriate for every patient, it can provide benefits over surgery, especially since it is minimally invasive.
We are one of the few heart and vascular centers in the greater D.C. area using stent-grafts throughout the aorta, helping to refine and expand their use. We are also one of the few programs in the area combining endovascular repair with open surgery to help patients with particular aneurysms. Learn more about our hybrid aneurysm repair.
Minimally Invasive Aneurysm Repair: Benefits and Challenges
Endovascular aneurysm repair can provide several advantages over traditional, open surgery:
- Provides an option for patients too frail or sick for surgery
- Smaller incision(s)
- Less pain
- Shorter hospital stay and recovery
- Less chance of complications
Endovascular Aneurysm Repair: Steps
Successful endovascular aneurysm repair requires several steps:
- Our team runs additional tests to make sure you are a good candidate for this type of repair, as well as to choose the best stent-graft.
- A team member administers local anesthesia and a sedative, or general anesthesia.
- Using X-rays and special dye for guidance, a guide wire and then a catheter are threaded through the arteries to the aneurysm.
- The collapsible stent-graft is put into the catheter and positioned over the aneurysm. It is then fixed in place and opened to reinforce the aorta’s wall.
- Hospital recovery typically takes 2 to 3 days.
Aneurysm Follow-Up Care
Following discharge from the hospital, you are asked to come back within a certain amount of time for a checkup and ultrasound or CT scan. We are also likely to recommend some lifestyle changes:
- Watch your blood pressure and weight
- Eat foods lower in fat, cholesterol and calories
- Quit smoking (if applicable)