Aortic disease: Expert care for complex aortic conditions

UW Health’s team of vascular and cardiothoracic surgeons are among the region’s most experienced team of experts in aortic disease.

Overview

Conditions frequently undiagnosed until emergencies

The aorta is the largest artery in the body. It carries oxygen-rich blood from the heart to the rest of the body, ensuring that a person’s organs, muscles and tissues function properly.

Thankfully, aortic problems are rare but when they happen, they can be life-threatening. In some cases, they are discovered randomly, such as when someone has a CT scan, MRI or ultrasound for another reason.

Unfortunately, some aortic problems are not recognized until someone feels a sudden tearing or stabbing sensation in the chest. In this case, 911 should be called immediately because the person needs to get to a hospital immediately. At UW Health, our goal is to treat aortic problems before they become life-threatening.

Symptoms and diagnosis

Symptoms to watch out for

Any of these symptoms could be a sign of an aortic problem. Seek immediate medical attention if you experience any or more of these:

  • Dizziness or lightheadedness

  • Rapid heart rate

  • Sudden, stabbing-like chest pain, belly pain or back pain

  • Heavy sweating

  • A pulse near the belly button

  • Difficulty breathing or shortness of breath

  • Painful or difficulty swallowing

  • Arm swelling

  • Loss of vision or ability to speak

  • Not being able to use arms or legs on one or both sides

Types of aortic problems

Aortic aneurysm

This occurs when the wall of the aorta bulges outward, similar to an inflating balloon. Smaller aortic aneurysms usually do not cause problems but if the bulge gets large enough, the aorta can rupture, causing internal bleeding and a need for immediate surgery. There are several types of aortic aneurisms:

  • An ascending aortic aneurysm occurs at the start of the aorta, before it reaches the top of the candy-cane shaped arch.

  • A thoracic aortic aneurysm occurs in the section of the aorta located between the heart and the chest.

  • A thoracoabdominal aortic aneurysm occurs further down, roughly at the midpoint of the torso. Because this part of the aorta connects to arteries that supply blood to the liver, kidneys, intestines, and spine, repairing this aneurysm can be more complicated than other aortic repairs

  • An abdominal aortic aneurysm occurs in the lowermost segment, below the chest.

Aortic dissection

This occurs when there is a tear in a weak part of the inside of the aortic wall. The tear allows blood to surge in between the layers of the aortic wall, and this can lead to a rupture and sudden stabbing-like pain. This can be a life-threatening condition because blood that is normally routed to the rest of the body starts flowing to the site of the aortic dissection.

  • A Type A dissection begins in the upper part of the aorta. This usually requires emergency open chest surgery to repair.

  • A Type B dissection begins further down the aorta. Some Type B dissections require surgery and others do not.

Aortic coarctation

A coarctation, which can be present at birth, is a narrowing of the aorta, making it harder for blood to flow freely.

Treatment

Options tailored to you

Non-surgical treatment

Treatment of an aortic aneurysm or dissection is not the same for everyone. For those with a smaller aortic problem, healthy lifestyle changes may be enough to slow the growth of the aneurysm or dissection and reduce the chance of a rupture. These may include:

  • Quitting smoking

  • Eating healthier

  • Managing stress

  • Getting more exercise

Medication may also be recommended, especially for people who already have high blood pressure, coronary heart disease, chronic kidney disease or high cholesterol.

Surgical treatment

Surgery is typically recommended to repair large aortic aneurysms, most Type A aortic dissections and some Type B dissections. Depending on the nature and extent of the problem, these repairs are done one of two ways:

Open surgical repair is the most common type of surgery. After the person is put to sleep, the surgeon makes a cut in the chest or stomach area, depending on the location of the problem. The surgeon will cut out the defective segment and replace it with a graft or synthetic tube. The surgeon sews the aorta back together before closing the incision.

Open surgery typically lasts about four to six hours. Patients typically remain in the hospital for five to seven days and start to feel stronger in about two weeks. Full recovery usually comes about two to three months after surgery.

Open repair options

The David procedure – also known as a valve-sparing aortic root replacement – is an advanced open-heart surgery. This procedure is used to repair certain ascending aortic aneurysms (aneurysm near the heart). During this procedure the surgeon is able to replace the ascending aortic aneurysm without the need to replace the aortic heart valve. Additionally, this technique simultaneously allows the surgeon to repair that valve if it happens to leak.

The Bentall procedure is a complex open-heart surgery where the surgeon replaces the aortic valve and ascending aortic aneurysm (aneurysm near the heart).

Aortic valve repair is an open-heart surgery where the patient’s own valve is repaired, avoiding valve replacement with a mechanical or bioprosthetic valve. Aortic Valve repair can be preformed at the same time as ascending aortic aneurysm repairs.

Aortic arch replacement surgery is a highly complex open-heart surgery where surgeons replace the damaged portion of the patient’s aortic arch.

Open thoracoabdominal aortic aneurysm repair is a complex operation that requires a large incision on the left side of the chest extending onto the abdomen. The surgeon replaces the damaged portion of the artery with a graft and re-attaches the arteries to the intestines and kidneys.

Open abdominal aortic aneurysm repair requires an incision in the patient’s abdomen allowing the surgeon to remove the damaged portion of the patients aortic and replace it with a graft.

Specialized endovascular repair options

Endovascular repair is a less invasive treatment that can be done for certain patients with an aortic aneurysm or dissection. Because the chest or abdomen is not opened, people recover faster than with open surgery. However, more follow up with CT scans is required post-operatively. After the person is put to sleep or given sedation, the surgeon inserts a catheter, or thin tube near the groin area. Sometimes access in one or both arms is also required depending on the complexity of the repair.

The catheter travels up through a blood vessel until it reaches the aorta. Using image-guided technology, the surgeon places and then releases a stent at the site of the defect. Constructed with fabric and a metal mesh frame, the stent provides necessary reinforcement to restore free flow of blood and reduce the chance of a future rupture.

Patients who have endovascular repair often go home the day after the procedure and are feeling like themselves after two to three weeks.

Thoracic endovascular aortic repair is a graft procedure used to treat aortic aneurysm in patient’s chest.

Single side branch TEVAR can be used in certain patients to treat aneurysm or dissection that extends into the aortic arch. This stent has one branch that can be used to continue to supply blood to the arm or brain while treating the aorta.

Fenestrated endovascular aneurysm repair is a procedure where branched grafts are placed in an abdominal aortic aneurysm. There are many arteries that branch off of the aorta within the abdomen. These arteries carry blood to organs in your abdomen, and this can make placement of grafts more difficult. The FEVAR option allows for repair of the abdomen aortic aneurysm without blocking blood flow to vital organs.

Thoracoabdominal Branch Endoprosthesis is a complex procedure that involves the use of specially made stent grafts that are used to treat aortic aneurysms in patient’s upper abdomen that extend into the chest. This graft allows branches to be built to the arteries that supply the organs in the abdomen.

Endovascular aortic aneurysm repair is used for aneurysms in the infra-renal aorta. During this procedure the surgeon builds a “pair of pants” inside the aorta and iliac arteries to exclude the aneurysm from blood flow.

This type of repair is used alone or in combination with EVAR to treat aneurysms of the common iliac artery while maintaining blood flow to the leg and buttock muscles.

Hybrid Aortic Procedures involve the combined use of endovascular grafts and open repair techniques to repair aortic aneurysms. Sometimes these procedures are done in stages.

Meet our team

Aortic care experts

We understand that aortic disease can be a stressful and confusing diagnosis. Our team includes many specialists to care for you including heart surgeons, vascular surgeons, cardiologists, nurse practitioners, physician assistants, registered nurses, radiologists and genetic specialists. Our team works together to review and recommend the best treatment options for your condition.

Displaying 6 of 13

Locations

Locations throughout Wisconsin and northern Illinois

  • 1 S Park St Medical Center Vascular Surgery Clinic
    • 1 S Park St / Madison, WI
    • (608) 263-8915
  • Eastpark Medical Center Vascular Surgery Clinic
    • 4621 Eastpark Blvd / Madison, WI
    • (608) 914-0700
  • Junction Rd Medical Center Vascular Surgery Clinic
    • 451 Junction Rd / Madison, WI
    • (608) 263-8915
  • 9th St Clinic Vascular Surgery Clinic
    • 209 9th St Suite 200 / Rockford, IL
    • (779) 696-8799
  • University Hospital Cardiac Surgery Clinic
    • 600 Highland Ave / Madison, WI
    • (608) 915-0200
  • University Hospital Heart Valve Clinic
    • 600 Highland Ave / Madison, WI
    • (608) 915-0200
  • Marshfield Medical Center - Beaver Dam Vascular Surgery Clinic
    • 705 S University Ave Suite 500 / Beaver Dam, WI
    • (608) 915-2300
  • Fort HealthCare Vascular Surgery Clinic
    • 611 Sherman Ave E / Fort Atkinson, WI
    • (920) 568-6567
  • Portage Clinic (Regional) Vascular Surgery Clinic
    • 2977 County Hwy CX / Portage, WI
    • (608) 745-3399
  • Reedsburg Area Medical Center Vascular Surgery Clinic
    • 1104 21st St / Reedsburg, WI
    • (608) 593-6050
  • Richland Hospital Vascular Surgery Clinic
    • 333 E 2nd St / Richland Center, WI
    • (608) 647-6161
  • Sauk Prairie Hospital Vascular Surgery Clinic
    • 250 26th St Suite 120 / Prairie du Sac, WI
    • (608) 643-6060
  • Southwest Health Center Vascular Surgery Clinic
    • 1400 Eastside Rd / Platteville, WI
    • (608) 330-6010