Aortic disease: Expert care for complex aortic conditions

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.

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.

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.

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.