Endovascular surgery on the aorta

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 treats various aortic problems:

• Aneurysms of the ascending aorta and aortic arch: these develop in the mainpart 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.