Aortic surgery is a therapeutic procedure to resolve issues with the largest artery in the body, and with the development of medical techniques, doctors are able to choose between multiple surgical interventions ranging from traditional operations to minimally invasive procedures, and in critical cases this surgery may be an emergency life-saving operation, but its results are much better when performed in a planned manner.
More than 50,000 procedures are performed annually in the United States alone, emphasizing the prevalence of these conditions and the importance of surgical solutions to aortic issues.
What is aortic surgery?
Aortic surgery is a surgical procedure that corrects issues with the aorta, which carries oxygen-rich blood from the heart to the rest of the body. This artery extends from the heart to the abdominal area, where it branches into arteries that feed the lower extremities. The need for this surgery arises when the wall of the aorta weakens, leading to expansion and the formation of an aneurysm, or when its inner layer tears and causes a dissection, and these issues may lead to a complete rupture of the artery wall, a life-threatening event.
When aortic surgery is necessary
Aortic surgery is required in the following cases:
- Aneurysm: The most common, an abnormal bulge in the artery wall, often caused by tissue weakness. Surgery is necessary when the diameter reaches 5 cm for the abdominal aorta and 5-5.5 cm for the thoracic aorta
- Aortic dissection: A tear in the inner layer of the artery that causes the wall to separate and blood to flow between its layers. Type A (ascending) requires immediate intervention.
- Severe aortic valve stenosis: Narrowing of the valve prevents blood flow from the heart to the aorta. Surgery is necessary when valve replacement is needed.
- Traumatic aortic injuries: Rupture of the aorta resulting from severe trauma (car accidents, falling from a height).
Types of aortic surgery
The type of aortic surgery is chosen based on the location of the injury and the patient’s condition, and is mainly divided into:
- Open surgery: A large incision in the chest or abdomen for direct access to the aorta
- Aortic valve replacement: Used to treat valve stenosis or blood backflow through the valve, replacing it with a mechanical or biological valve.
- Aortic root replacement: Performed when the valve-artery connection is damaged due to aortic root dilation or rupture (Marfan syndrome), with a graft implanted that includes the valve and part of the artery.
- Ascending aortic replacement: Replacing the segment between the heart and the aortic arch with a Dacron tube (artificial graft) to treat aneurysms or dissections in the ascending segment. This may be combined with valve or root replacement if these tissues are affected (in cases of acute aortic dissection type A).
- Aortic arch replacement or descending thoracic aorta repair: In this procedure, the damaged portion of the aorta in the chest is removed and replaced with an artificial graft to address aneurysms or dissections.
- Abdominal aortic aneurysm repair: Replacing the dilated segment with an artificial graft to prevent rupture when abdominal aortic aneurysms are large and unsuitable for catheterization.
- Transcatheter angioplasty: This is a therapeutic technique used to treat aortic aneurysms without the need for a major surgical incision. A thin catheter is inserted through a small incision in the groin area, and a covered stent is passed through it until it reaches the damaged part of the artery. The stent is then positioned at the site of the aneurysm, allowing blood to flow without compressing the aneurysm, significantly reducing the risk of the artery bursting. Transcatheter angioplasty is divided into two types based on location:
- TEVAR: For the descending thoracic aorta (the part behind the heart).
- EVAR: For the abdominal aorta (above the pelvis).
Comparison of open and catheter surgery
| Element | Open surgery | Catheterization surgery |
| Surgical scar | Large in the abdomen or chest | Small in the thigh |
| Duration of surgery | 3 to 6 hours | Approximately 1.5 to 3 hours |
| Length of hospitalization | 5 to 10 days | 1 to 3 days |
| Full recovery time | 3 to 6 months | A few weeks to 3 months |
| Suitable for every situation | Younger patients or those who tolerate major surgery – Conditions that cannot be treated with catheterization due to the location of the aneurysm or its complex anatomy | Older patients or those with chronic health conditions |
Aortic surgery preparation and initial procedures
Before aortic surgery, you will be asked to inform the doctor of all medications and supplements that you use and you may be asked to stop some of them, especially blood thinners, you will have tests such as ECG, blood tests and radiographs, it is important to attend these appointments and understand the details of the operation and the risks associated with it, in addition to refraining from eating and drinking after midnight before surgery, bathing with special medical soap, it is also recommended to quit smoking early and avoid contact with patients or traveling before the operation to reduce the risk of infection.
On the day of surgery, you will arrive at the hospital early and meet with the anesthesiologist who will explain the anesthesia plan and answer any questions, after that the medical team will prepare you for the operation, you will undergo general anesthesia, which means you will be completely asleep and will not feel any pain during the surgery, it is also recommended to have a companion to take you home after the initial recovery.
Risks and possible complications
Complications vary depending on the type of aortic surgery and include:
- Bleeding
- Clots
- Stroke
- Renal failure
- Infection
- Cardiac arrhythmia
Rare complications such as leg paralysis or respiratory failure may occur, and the risks are higher in the elderly or those with chronic diseases, but surgery is still less risky than leaving an aortic aneurysm or tear untreated.
Recovery after aortic surgery
The recovery journey after aortic surgery is divided into two phases:
- Early recovery: The length of stay in the hospital depends on the type of surgery, after open surgery the patient usually stays about a week, while the catheterization patient is discharged within one or two days, and during this period, vital signs are monitored, and the patient begins simple movement where adherence to medications and avoiding any strenuous physical activity is observed, in addition to rest and attention to good nutrition are important factors at this stage
- Long-term recovery: After leaving the hospital, recovery continues at home, full recovery from open surgery requires about 8 to 12 weeks, while catheterization usually does not exceed 2 to 3 weeks, and work can be resumed gradually as the condition improves, and attending medical appointments, following the doctor’s instructions, and paying attention to safe physical activity are essential steps to avoid any possible complications.
Life after aortic surgery
This stage requires continuous commitment to maintain the results of the surgery, blood pressure must be strictly controlled using medications with complete cessation of smoking, cholesterol and diabetes must be monitored to reduce pressure on the arteries as it is necessary to follow a healthy diet and moderate physical activity, and in some cases additional surgeries may be needed in the future, especially after installing a stent, and regular follow-up and commitment to treatment ensures a stable life and better health quality in the long run.
In conclusion, aortic surgery is a crucial step in the treatment of serious diseases, and its success depends not only on the operation itself, but also on the patient’s awareness and commitment to treatment and follow-up, and by maintaining a healthy lifestyle and cooperating with the medical team, the patient can regain a normal and safe life.
Sources:
- Hiratzka, L. F., et al. (2014). 2010 Guidelines for the diagnosis and management of thoracic aortic disease. NCBI Bookshelf.
- Society for Vascular Surgery. (n.d.). Open surgery treatment for aortic dissection. Vascular.org.
