Aortic Aneurysm Treatments

Genes may play a role in whether you develop an aortic aneurysm, particularly a thoracic aortic aneurysm (TAA). Conditions that increase the risk of aortic aneurysm include:

• family history of thoracic aortic aneurysm and dissection (TAAD)
• Marfan syndrome
• Loeys-Dietz syndrome
• type IV (vascular) Ehlers-Danlos Syndrome
• polycystic kidney disease
• Turner syndrome
• aneurysm-osteoarthritis syndrome
• bicuspid aortic valve

The Aortic Center provides comprehensive services for individuals who may have an increased risk of aortic aneurysm due to genetic factors. These include:

• latest genetic testing
• individualized counseling about genetic test results
• coordination of multidisciplinary care with medical and surgical specialists
• long-term follow-up care

Often an aortic aneurysm that has not caused symptoms may be found by chance during a routine physical exam or imaging test performed for another reason.

Aortic aneurysm screening is available to detect an aortic aneurysm before symptoms appear. Screening is particularly if you are a man over 65 who has smoked, or a man or woman with a family history of aortic aneurysm.

Accurate imaging is an essential first step to diagnose and treat of all types of aortic disease. Our Non-Invasive Cardiac Imaging Program conducts imaging studies of aortic aneurysm patients to diagnose aortic conditions. Imaging also provides an in-depth view of your anatomy to guide pre-operative evaluation. Imaging tests include: 

• CT (computerized tomography)
• ultrasonography
• MRI (magnetic resonance imaging)
• transesophageal echocardiogram
• angiography

Not all aortic aneurysms require surgical treatment. Depending on the size and symptoms of your aneurysm, your condition may be managed medically, with the goal of slowing aneurysm growth and reducing the risk of rupture. 

Medical management involves:

• thorough evaluation
• imaging exams performed over time to monitor aneurysm growth
• medications to reduce blood pressure, cholesterol and heart rate
• counseling to help you make lifestyle changes that may reduce your risk

Medical Director Brett Carroll, MD, communicates and coordinates care with Aortic Center surgeons and other medical or surgical specialists to ensure you receive the best treatment.

Co-Director Marc Schermerhorn, MD, and other members of the Aortic Center surgical team are nationally recognized innovators in developing minimally invasive endovascular procedures. Because of our expertise and experience, endovascular aneurysm repair (EVAR) is often the first choice for treatment, even if you might not be a candidate for endovascular treatment elsewhere.

Endovascular repair does not require large incisions and may be performed without general anesthesia. Other benefits include:

• shorter hospital stay
• less scarring
• faster return to normal activity
• reduced risk of complications
  
  

The EVAR Procedure

During the procedure, the surgeon inserts a catheter through small incisions in the groin and/or arms. A device called a stent-graft is placed through the catheter into the damaged section of the aorta. The stent-graft acts as a support to take pressure off the wall of the aorta, and helps restore blood flow and prevent aneurysms from rupturing.

Innovative Imaging for EVAR

State-of-the-art imaging technology called Vessel Navigator guides surgeons throughout endovascular procedures, providing a precise view of your blood vessels, and enabling complex aneurysm repairs. BIDMC helped develop Vessel Navigator, and was one of the first medical centers in the world to use this technology. Today, the Aortic Center uses Vessel Navigator to guide nearly all endovascular procedures.

Percutaneous Endovascular Repair

The Aortic Center is also a leader in percutaneous (incision-less) endovascular repair, a technique BIDMC helped to pioneer and has perfected. Today, 90 percent of patients undergoing endovascular treatment in BIDMC’s Aortic Center are treated with the percutaneous approach, compared to 20 percent nationally. Percutaneous repair uses punctures in the skin, rather than small incisions, to position the stent-graft into the aneurysm. BIDMC research shows that this percutaneous approach reduces complications, operating room time, and length of hospital stay.

VesselNavigator Imaging System

This sophisticated technology guides minimally invasive repair of aortic aneurysms. The imaging system was developed by surgeons at BIDMC, one of the world's first institutions to use this state-of-the-art navigation technology.

VesselNavigator provides surgeons with a continuous 3-D "roadmap" to guide them through a patient's blood vessel system during complex aortic procedures, enhancing the accuracy of stent and graft replacement, reducing the need for contrast agent, and improving patient outcomes

Customized, Fenestrated and Branched Stent Grafts

Our surgeons are leaders in developing custom-built stent grafts, which provide a precision treatment option for patients with complex anatomy. These include:

• individually customized stent grafts
• branched stent grafts
• fenestrated stent grafts, which have special openings called fenestrations that are customized to the patient's unique anatomy, allowing blood to flow from the aorta to vital organs.

Our experience and positive outcomes in the use of the newest stent grafts allow us to offer an endovascular approach to more patients.