The scope of endovascular surgery is increasing every year as techniques and technology develop at a rapid pace. Endovascular techniques are replacing and complementing traditional open vascular surgery for many conditions. A major part of the work of an endovascular surgeon involves the aorta.

The aorta is the main artery that leads from the left ventricle of the heart. It gives off branches to take blood to the arms, legs, head, and to all the organs in the chest and abdomen.

When the aorta leaves the heart, it moves up through the chest towards the head forming the ascending aorta. It then arches and passes down through the chest and abdomen; this is the descending aorta.

Aneurysms can form in the aorta at any point. They are less common in other blood vessels but may also affect the popliteal artery behind the knee and the femoral arteries in the groin.

What is an aneurysm?

An aneurysm develops when the wall of the artery becomes weak. Normally the strong smooth muscle in the thick wall of the artery keeps it in shape. If the muscles cannot withstand this pressure on them from the blood leaving the heart, the artery walls balloon outwards, forming a swelling. The pressure of blood causes this swelling to grow, which can burst. A ruptured aortic aneurysm can be fatal.

Do all aortic aneurysms need surgery?

Not all aortic aneurysms require surgical treatment. If an aneurysm is small, less than about 5 cm (2 inches) in diameter, constant monitoring is best as the risks of surgery may outweigh the benefits.

If a small aneurysm starts to extend or increase in diameter, endovascular surgery or open vascular surgery may be the best option. There are few, if any symptoms to warn of these changes. For this reason, regular examinations with ultrasound scans are required to monitor the size of the aneurysm.

Endovascular specialists at The London Clinic regard an aneurysm as becoming more dangerous if it measures more than 5.5 cm in diameter or if it expands in diameter by at least 0.5 cm in a 6-month period. Under these circumstances, surgical treatment is usually required. It is also important to report any symptoms to your consultant in between examinations, including chest pain or breathlessness, for example.

Open surgery versus endovascular techniques

Open surgery for aortic aneurysms has been offered for many years, so the success rates and risks have been well studied.
The mortality rate for open surgery on an aortic aneurysm is approximately 5 people in every 100 who have the operation. This is a basic guide; each patient has their own unique set of risk factors.

Patients with other health conditions such as kidney disease, liver disease, lung problems or diabetes are at the greatest risk. Some people may be too ill for open surgery.

The mortality rate for endovascular treatment of an aortic aneurysm is, on average, one third of that associated with conventional open surgery.

Endovascular surgery has different associated risks but is carried out by an expert and experienced team at The London Clinic. Our patients have the reassurance of knowing they are in the best possible hands.

Our endovascular surgeons are among the best in the world and are capable of dealing with complications and emergencies that may arise. Our critical care unit (CCU) is a level 3 unit, which means it is as good, if not better, than the CCUs in the major London teaching hospitals. Many private hospitals do not have on-site CCU units.

Endovascular techniques and the aorta

Endovascular surgery is treats various aortic problems:

  • Aneurysms of the ascending aorta and aortic arch: these develop in the main part of the aorta as it leaves the heart.
  • Aneurysms of the aorta in the abdomen: the site of the aneurysm is further from the heart where the aorta passes through the abdominal cavity.
  • Aneurysms of the aorta that develop in the chest: these are known technically as thoracic aortic aneurysms.
  • Thoracoabdominal aortic aneurysms: these develop when the aorta balloons and an aneurysm forms in the artery as it passes from the chest and to the abdomen.

Aortic dissections (tear in the lining of the aorta)

An aortic dissection occurs when the wall of the aorta develops a tear in the inner lining. The wall of the main artery splits into two channels. The result is that blood still flows through the main channel, the lumen of the aorta, but it also flows in the false channel.
This channel can extend progressively to involve more of the aorta and, because the wall is thin, it can expand and rupture in a similar way to an aneurysm.

If the dissection process involves the branches of the aorta, these can become blocked. This starves the tissues of their blood supply and may have serious consequences.

Patients affected by an aortic dissection are generally younger than those who develop an aortic aneurysm.  Both conventional open and endovascular treatments can be used to treat aortic dissections. Clinical decisions depend on which the part of the aorta is affected and whether there are additional complications.