The largest artery in the body, the aorta is essential for carrying oxygen-rich blood around the body. The aorta can be affected by a number of diseases that can cause it dilate, commonly known as an aneurysm or to split, known as a dissection.
These diseases of the aorta are commonly due to atherosclerosis, which means hardening of the arteries and is often associated with high blood pressure, high cholesterol, smoking and certain genetic connective tissue disorders. Injury or trauma can also cause a dissection or aneurysm.
Aortic aneurysms occur in two main places:
- Abdominal aortic aneurysms occur in the abdomen
- Thoracic aortic aneurysms occur in the chest and are less common than abdominal aortic aneurysms
Although a small degree of widening of the aorta is common and usually harmless larger sizes are more likely to have symptoms. An aortic aneurysm that ruptures is often fatal.
- Tearing pain in the chest or between the shoulder blades (thoracic aneurysms) or lower abdominal or back pain (aortic aneurysms)
- Rupture may trigger loss of consciousness or collapse
This can be a difficult condition to diagnose as there is often few symptoms. Mr Darby will perform a number of tests possibly an ultrasound or CT scan. Patients often come to him having been diagnosed incidentally by a test performed by another specialty or a screening on the NHS or private health check.
If an aneurysm is detected then it should be monitored if small as there is a risk of rupture as the aneurysm gets larger. Once the decision is made to repair the aorta then a full heart check is carried out.
There are two options for repair either open surgery of an endovascular (key hole) technique. Which is chosen depends on the individual patient and the shape of the aorta and patient preference.
In the open repair the weakened section of the aortic artery may be surgically replaced with a graft of artificial material through a surgical incision in the abdominal wall.
Mr Darby will perform this under general anaesthesia and there will be a hospital stay of 5 to 6 nights to recover. This would be at the John Radcliffe Hospital and involve one day’s stay in the intensive care unit.
Endovascular aneurysm repair (EVAR), is also known as stent grafting. As with the surgical option, it involves using an artificial graft to repair the artery. Mr Darby will insert the graft known as a stent, mounted inside a slender tube, through the femoral artery in your groin and up through the aorta to where the aneurysm is sited. The graft repairs the artery wall and your blood flows through the stent.
This isn’t an option for everyone – it depends on the shape and site of the aneurysm and whether your arteries are large enough or straight enough for the stent – and Mr Darby will be able to advise you if you’re suitable.
EVAR can be performed under a general or a local anaesthetic and usually requires 3 nights in hospital. This can be performed at the John Radcliffe or in the fully private setting of the Manor Hospital Oxford.
For more information on the EVAR procedure, click here.