Aortic Aneurysm and Aortic Dissection

The aorta is the largest blood vessel in your body. Extending from the left chamber of your heart all the way down through your abdomen and into your pelvis, the aorta carries blood from your heart to the rest of your body.

Because the aorta is so long, different sections have different names. Inside your chest cavity the aorta is called the “thoracic aorta,” and in your abdomen it’s referred to as the “abdominal aorta.”

Given its critical role in transporting oxygen-rich blood to all of your organs, any disease or damage affecting your aorta can lead to serious health problems. In many cases, aortic disorders are life-threatening and require immediate care. To that end, it’s important to seek care from vascular surgeons who can properly diagnose your symptoms and provide effective treatment.

Scripps vascular surgeons have experience treating the full range of vascular diseases that affect the aorta, including:

• Abdominal aortic aneurysm, which occurs when a portion of the abdominal aorta begins to bulge, similar to a balloon inflating. If the bulge bursts before it’s repaired, it can cause severe internal bleeding that may be life-threatening.
• Thoracic aortic aneurysm, which occurs when a portion of the thoracic aorta begins to bulge. If it ruptures prior to treatment, internal bleeding may be severe enough to cause shock or death.
• Thoracoabdominal aneurysm, similar to the aneurysms described above, occurs when there is bulging and weakness in the portion of the aorta that passes from the chest into the abdomen.
• Aortic dissection is a rare but serious condition in which the inner layer of the aorta tears. As blood rushes through the tear, it causes the inner and middle layers of the aorta to “dissect” or separate from one another. As blood continues to fill this space where the layers have separated, it can rupture through the aortic wall and cause fatal internal bleeding.
• Aortoiliac occlusive disease occurs when your iliac arteries (which branch off from the aorta within your abdomen) become narrowed or blocked by a sticky substance called plaque. The iliac arteries divide into smaller arteries that run down your legs to your toes; any blockage within these blood vessels means there is reduced blood flow to your legs.

In the early stage of the condition, people with aortic disease often do not have symptoms. As time goes on you may experience warning signs that signal an impending aneurysm or dissection. Those symptoms will depend on where in the aorta your aneurysm is located.

Aortic aneurysm symptoms may include:

• Sudden pain in your chest or abdomen
• Sudden pain your upper or lower back
• A pulsing feeling in your abdomen
• Difficulty breathing

Aortic dissection symptoms may include:

• Sudden, severe pain in your chest or upper back that feels like something is tearing or ripping
• Shortness of breath
• A weak pulse in one arm 
• Possible loss of consciousness

Risk factors for aortic disease include:

• Smoking
• High cholesterol
• High blood pressure
• Obesity
• Diabetes
• Age (risk goes up over age 65, particularly in men)
• People who have a pre-existing genetic condition (such as Marfan syndrome) or a connective tissue disorder (including Ehlers-Danlos disorder and scleroderma)

Scripps physicians can detect aortic disease using one or more of the following tests:

• Abdominal ultrasound, an imaging test that can assess both the blood vessels located within the abdomen and the abdominal organs including the kidneys and pancreas
• Computed tomography (CT) scan, a painless, noninvasive way to see inside the body using X-ray imaging
• Magnetic resonance imaging (MRI) scan, a procedure that uses a powerful magnet, radio waves and computer technology to produce pictures without using ionizing radiation
• Computed tomography angiography (CTA), a procedure where contrast dye is placed intravenously (IV) and then used by the CT scanner to create the images of blood vessels
• Magnetic resonance angiography (MRA), a type of MRI that is used to look at blood vessels and the way blood is flowing through them
• Intravascular ultrasound (IVUS), a specialized imaging procedure that uses catheters to see inside an artery, including the amount of plaque built up along the artery wall

Scripps is proud to offer the San Diego community access to vascular surgeons who perform the most advanced procedures available for treating complex and often serious aortic conditions. These include procedures for aortic aneurysm treatment and aortic dissection treatment, such as:

• Endovascular aneurysm repair (EVAR), also referred to as an endovascular stent graft, is a minimally invasive procedure that allows surgeons to reinforce a weak spot in an artery wall with a tiny mesh tube called a stent. Typically used to treat abdominal aortic aneurysms and thoracic aortic aneurysms, an endovascular stent graft is tailored to fit a person’s specific anatomy.
• Thoracic endovascular aneurysm repair (TEVAR) is a minimally invasive alternative to conventional open surgery in people who have an aneurysm in the portion of their aorta that lies within the chest cavity. During the procedure, a vascular surgeon reinforces a weak portion of the thoracic aorta with a stent.
• Fenestrated endovascular aneurysm repair (FEVAR) is a minimally invasive treatment for people with an aortic aneurysm or aortic dissection, specifically in the section of the aorta that branches off and carries blood to your kidneys and other nearby organs. The name derives from the small openings in the stent device, called fenestrations, which a vascular surgeon precisely positions in the aorta. Once the stent is placed in the aorta, the fenestrations allow blood to continue flowing to the surrounding organs.
• Hybrid aortic aneurysm repair is a specialized procedure used primarily to treat people with a thoracoabdominal aneurysm. The so-called hybrid approach means that vascular surgeons use a combination of open and endovascular surgical techniques.
• Open surgical repair is still a preferred treatment option for many people who require aneurysm repair. While newer endovascular techniques are a viable option for many people, other patients may not be candidates due to the shape or location of their aneurysm. Conventional surgery is a safe, effective option, especially for people who are at lower risk for surgical complications.

Scripps Health offers comprehensive endovascular and vascular treatment in San Diego at the following locations:

• Scripps Clinic Carmel Valley
• Scripps Clinic John R. Anderson V Medical Pavilion
• Prebys Cardiovascular Institute
• Scripps Green Hospital
• Scripps Memorial Hospital Encinitas
• Scripps Memorial Hospital La Jolla
• Scripps Mercy Hospital San Diego