Aortic Disease: Treatment Options

The complex nature of aortic disease and significant variations in presentation of individual patients requires a multidisciplinary approach that is unique and individualized and includes all aspects of surgical technique and lifelong medical treatment.

We provide surgical and medical consultation to review specific treatment strategies on a collaborative basis that will help confirm and characterize the aortic disease process in combination with optimal medical treatment and establish a surgical threshold.

For treatment of Aortic Disease, we offer:

Surveillance and medical management

• Watchful Waiting: "Watchful waiting" is commonly recommended for a patient whose aneurysm is small and asymptomatic. In such cases, the physician will keep a close watch on the patient's condition with periodic CT or MRI scans, blood pressure contro, treatment of high cholesterol if indicated. Our patients receive life-long management with annual follow-up even after surgery

• Medication: You may be given medicine to slow the growth of your Thoracic Aortic Aneurysm and decrease the risk of rupture. If the patient has hypertension, the physician may prescribe a blood pressure medication in order to reduce strain on the weakened portion of the aorta. A cholesterol-lowering medication such as a "statin" may also be prescribed. Recent advances have demonstrated that in certain, limited situations, medical management may in fact reverse the growth process.

Aortic Surgery Options

• Aortic Aneurysm Surgery: Larger thoracic aortic aneurysms may require a surgical repair known as an aneurysmectomy. This involves removing the portion of the aorta that contains the aneurysm and replacing it with a synthetic graft. An aneurysmectomy involves general anesthesia, open-chest surgery, and a hospital stay of five days or more. If the aneurysm involves important branches of the aorta, these vessels may be repaired or bypassed.

• Aortic Dissection Surgery: Surgery is required depending on the location of the aortic dissection and if the aortic dissection causes the artery to leak blood, blocks the blood supply to the legs or to the vital organs in the abdomen, causes symptoms, is enlarging, or occurs in a person with Marfan's syndrome. This involves removing the largest possible area of dissected aorta, close to the false channel between the middle and outer layers of the aortic wall and replacing it with a synthetic graft.

• Endovascular Stent Surgery: Most thoracic aortic aneurysms are now treated with a minimally invasive approach called endovascular stent-graft repair, instead of conventional surgery. In this approach, a catheter is used to insert and guide a stent-graft (a polyester tube covered by a tubular metal web) into the aorta to the site of the aneurysm. The procedure begins by making a small incision in the groin and inserting the stent-graft into the femoral artery (which descends directly from the aorta). Using fluoroscopy (a continuous x-ray technique) and transesophageal echocardiography (TEE), the stent-graft is guided through the aorta to the aneurysm. With the stent-graft in place, blood flows through the stent-graft instead of through the aneurysm, eliminating the risk of rupture.

• Hybrid Surgery: is available for aortic arch debranching and stenting as well as  visceral debranching and stenting for thoraco-abdominal aneurysms

We offer virtually every open surgical approach including: 

• Composite Valve Graft Root Replacement (bioprosthesis or mechanical)

• Aortic valve-sparing root replacement (Modified David Re-implantation or Yacoub Remodeling procedures)

• Ross Procedure

• Aortic Homograft

• "Freestyle" valve and root replacement

• Thoraco-abdominal repair and replacement

Cutting Edge Minimally Invasive Endovascular Repair Surgery

NYU Langone Medical Center was one of the first centers in the United States to adopt the minimally invasive approach to aortic aneurysm repair. We continue to participate in numerous FDA clinical trials to further advance the technology of endovascular therapy for complex aortic disease that may include treatment for ascending aorta and aortic arch aneurysms, as well as acute dissections. The improvement in patient outcomes includes a quicker recovery, reduced blood loss, less pain, and the ability to perform these procedures under local and regional anesthesia. We have also been designated as the regional training center for branches and fenestrated EVAR, one of only twelve centers nationwide offering this procedure. This cutting edge technology will allow for greater endovascular options when treating juxtarenal and suprarenal aortic aneurysms, as well as descending and other thoracic aortic aneurysm hybrid procedures. Our team will determine the best surgical option for the patient based on the anatomical characteristics of the aneurysm in combination with our state- of –the- art imaging studies.