Surgery For Aorta

(A) SURGERY FOR AORTIC DISSECTION
Acute aortic dissection can be treated surgically or medically. In surgical treatment, the area of the aorta with the intimal tear is usually resected and replaced with a Dacron graft.

Emergency surgical correction is the preferred treatment for Stanford type A (DeBakey type I and II) ascending aortic dissection. It is also preferred for complicated Stanford type B (DeBakey type III) aortic dissections with clinical or radiologic evidence of the following conditions:

The initial management for an aortic dissection often occurs in the emergency room. A patient has an intravenous (IV) line placed, so that medications can be delivered directly into the blood stream. Blood pressure is reduced with medications, usually to 100 to 120 mmHg systolic. Pain is controlled with morphine.

If it is determined that an aortic dissection involves the ascending aorta (DeBakey type I and II or Stanford type A), this is considered a surgical emergency in most patients. Patients are immediately taken to the operating room for repair of the dissection.

If the dissection involves only the descending aorta (DeBakey type III or Stanford type B), the patient is usually treated with medications only. Surgery is usually not recommended for these patients unless complications occur.

 
(B) SURGERY FOR AORTIC ANEURYSMS
An aneurysm is a balloon-like bulge in an artery. Aneurysms can form in arteries of all sizes. An aneurysm occurs when the pressure of blood passing through part of a weakened artery forces the vessel to bulge outward, forming what you might think of as a blister. Not all aneurysms are life threatening. But if the bulging stretches the artery too far, this vessel may burst, causing a person to bleed to death. An aneurysm that bleeds into the brain can lead to stroke or death.

Where do aneurysms occur in the body?

Why do I need surgery?
Different operations treat the different kinds of aneurysms. Surgery to treat aortic aneurysms, those that occur in the body's main artery, depends on the size and location of the aneurysm and your overall health. Aortic aneurysms in the upper chest (the ascending aorta) are usually operated on right away. Aneurysms in the lower chest and the area below your stomach (the descending thoracic and abdominal parts of the aorta) may not be as life threatening. Aneurysms in these locations are watched for varying periods, depending on their size. If they become about 5 centimeters (almost 2 inches) in diameter, continue to grow, or begin to cause symptoms, you may need surgery to repair the artery before the aneurysm bursts.

What does the surgery involve?
Surgery involves replacing the weakened section of the vessel with an artificial tube, called a graft. This means that surgeons will have to open either the stomach area (for abdominal aneurysms) or the chest (for thoracic aneurysms).

The cardiovascular surgeon leads the surgical team, which includes other assisting surgeons, an anesthesiologist, and surgical nurses. When the operation begins, the surgeon will make a cut (called an incision) either in the abdomen or the chest. The incision depends on where the aneurysm is located.

Surgeons will then place clamps on the artery above and below the aneurysm to stop blood flow to that part of the aorta. Your heart and brain still get blood because other vessels take over.

The bulging section of the aorta is cut out (excised). The surgeon will then replace the missing piece with a fabric tube called a graft. The clamps are then removed slowly to allow blood to flow through the vessel again.