Aortic Disease

aorta-in-body1The aorta is the largest blood vessel in the body. It originates from the left ventricle of the heart and courses up through the chest than down into the lower half of the body. It provides direct branches to all the limbs and major organs. The wall of the aorta, as in all arteries, consists of three layers known as the adventitia (outer), media (middle), and intima (inner).  The aorta can be affected by aneurysmal disease, dissection, and atherosclerosis.

Aneurysmal disease is very closely associated with cigarette smoking. In aneurysmal disease, degradation of the protiens that make up the arterial wall results in loss of elasticity and dilation of the artery as the wall remodels. As the aorta dilates, the wall weakens and there is a risk that it may rupture. The risk for rupture increases with size. In the ascending aorta this may also affect how blood

leaves the heart by way of the aortic valve. In the descending thoracic (chest) portion and abdominal portions of the aorta the more common problem is rupture. The descending thoracic aorta should be evaluated for surgical treatment when it reaches 6 cm and the abdominal aorta when it reaches 5 cm. There are currently minimally invasive treatment options for both. Our practice is certified to offer both therapies.

In dissection, a small tear on the innermost layer, the intima, results in blood coarsing between the intima and media. This results in a false passage which may disrupt these two layers for the entire length of the aorta. This dissection may result in the loss of blood flow to vital organs as the normal anatomy is disrupted. This may occur as the result of trauma or uncontrolled hypertension. Dissections involving the ascending thoracic aorta, type A, are always surgical emergencies as they may disrupt blood flow to the brain and heart. Type B dissections originate beyond the left subclavin artery, the main artery to the left arm, and may be managed medically if no compromise to the distal vital organs or limbs occurs. Any obstruction of flow to a vital organ is a surgical emergency. Presently, there is a growing body of literature to support use of minimally invasive techniques to treat type B dissections although this is considered off lable use.

The aorta is also susceptible to atherosclerosis. This may result in obstruction of the aorta and its major branches resulting in diminshed or lost flow to limbs or vital organs. This may be remedied by minimally invasive techniques such as angioplasty and stenting or by bypass surgery.