An aneurysm is an abnormally dilated, or widened, section of an artery. Aneurysms can occur in any artery but most commonly affect the aorta, your body's largest artery, which runs from your heart through your chest and into your abdomen. An aortic aneurysm can occur in the chest (thoracic aortic aneurysm) or the abdomen (abdominal aortic aneurysm).
Because of the threat of rupture, an aortic aneurysm is considered very serious, and treatment is crucial. When aneurysms rupture, blood suddenly escapes and this hemorrhage is life threatening. In a related condition called aortic dissection, a tear in or other damage to the inner lining of the aorta results in bleeding into and along the aorta's wall. This dissects, or separates, the layers of the aortic wall. If not treated, aortic dissection may be fatal.
At Lenox Hill Heart and Vascular Institute, our goal is to prevent these potentially fatal conditions from occurring. Our skilled physicians will repair your aneurysm using the most advanced and effective techniques available. The collective experience of the physicians of Lenox Hill Heart and Vascular Institute in both open and endovascular procedures results in successful, world-class treatment of aortic aneurysm patients. Our staff includes some of the foremost physicians and leading authorities in the field, including Alfio Carroccio, MD, Richard Green, MD, Vicken Pamoukian, MD, Robert Rosen, MD, and Enrique Hernandez, MD.
Dr. Green is considered one of the foremost aortic surgeons in the United States and was an early adaptor of endograft insertions. With more than 30 years of experience, Dr. Green specializes in open or traditional surgeries and endovascular treatments for aneurysm treatments. Dr. Rosen is a leading authority on the management of endoleaks using catheter-based interventions. This highly seasoned team is fully able to deal with any complications that may arise. The group specializes in both aortic and thoracic aneurysms and is closely linked and works closely with an expert group of cardiac surgeons who can perform highly skilled work in the ascending aorta..
Treatment
Small aneurysms and those that do not cause symptoms may be treated with medication and observation. For larger, symptomatic aortic aneurysms, Lenox Hill Heart and Vascular Institute offers several different treatment options, including:
Open aneurysm repair. If you have a thoracic or abdominal aortic aneurysm, the physician may surgically repair your aorta. Depending on the location of the aneurysm, the surgeon will make an incision in your chest or abdomen and replace the diseased portion of aorta with a Dacron graft, a synthetic material used to replace body tissues. Your diet will be restricted for 2 to 3 days after surgery and you will remain in the hospital for about 1 week. Lenox Hill Heart and Vascular is the most experienced site for open surgery in New York City.
Aortic valve sparing root replacement. Since 2004, Lenox Hill Heart and Vascular Institute has been one of the few hospitals in the world to offer this relatively new procedure. Aortic valve sparing root replacement is an advanced technique that allows you to keep your own aortic valve while receiving a complete aneurysm resection, the surgical removal of defective tissue that causes a dangerous bulge in the aorta. This provides a more durable option than the animal or mechanical replacement valves typically used, and does not require lifelong use of anticoagulant drugs afterward. During the valve sparing procedure, the physician removes the entire aortic root, repairs the aortic valve as needed, and reincorporates it in the reconstruction of the aortic root. Because it does not require the use of anticoagulants, this approach is especially advantageous for young patients and for older patients who may face other unrelated surgeries after their aortic aneurysm surgery.
Endovascular stent graft. Following a very thorough anatomic evaluation by the vascular surgeon, some patients with abdominal aortic aneurysm may be eligible for placement of a stent within the aorta. This minimally invasive procedure allows surgeons to implant a tube made of synthetic fabric and metal that supports the diseased aorta from the inside and prevents further leakage or expansion without resorting to major surgery. The tube, called a stent graft or endograft, is threaded into your aorta using a catheter (a thin, flexible tube) inserted through a small incision into an artery in the groin. Sophisticated, real-time x ray imaging helps the surgeon guide the stent graft above and below the aneurysm. The graft stays in your body permanently and prevents blood from putting pressure on the damaged wall of the aorta and keeps the aneurysm from rupturing. Over time, the aneurysm generally shrinks. General anesthesia is still required but since the abdomen is not entered to accomplish the repair, you can be discharged from the hospital in roughly half the time.
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