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Types of Thoraco-Abdominal Aneurysms
Thoraco-abdominal Aortic Aneurysms involve the thoracic aorta and extend into the abdominal aorta. Thoraco-abdominal aortic aneurysms are classified according to the Crawford Classification:
•Extent I involves the subclavian artery and extends to the level of the renal arteries
•Extent II involves the subclavian artery and extends to the bifurcation of the aorta in the pelvis. This aneurysm expands the entire length of the thoraco-abdominal aorta.
•Extent III involves the middle of the descending aorta and extends to the bifurcation of the aorta in the pelvis.
•Extent IV involves the upper portion of the abdominal aorta and extends to the bifurcation of the aorta in the pelvis.
Thoraco-Abdominal Aortic Aneurysms: 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.
- 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 control,treatment ofhigh cholesterolif 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 Aneurysm Surgery: Larger thoracic aortic aneurysms may require a surgical repair. This involves removing the portion of the aorta that contains the aneurysm and replacing it with a synthetic graft. This procedure 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 various factors such as 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 connective tissue disorder. An aortic dissection repair involves surgically 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