The Center for Aortic Aneurysm Surgery Patient Guide centralbap.com What is an Aortic Aneurysm? An aortic aneurysm is dilation, bulging or ballooning of a weakened part of the wall of the aorta, the main artery that carries blood away from the heart. The normal pressure of blood from the pumping heart causes the weakened portion of the aorta to slowly stretch and bulge, leading to the formation of an aneurysm. Aneurysms can stretch to the point of rupture, which is life threatening and requires immediate medical attention. The key to successful treatment of an aneurysm is early diagnosis, careful monitoring and referral for surgical consultation to avoid rupture of the aneurysm. Fortunately, when aortic aneurysms are diagnosed early before they rupture, treatment is safe, effective and curable . 2 3 What is an Aorta Abdominal Aortic Aneurysm (AAA)? Abdominal aortic aneurysm (AAA) is the most common of the aortic aneurysms, affecting nearly 200,000 people in the United States annually. Up to 15,000 people per year die of a ruptured AAA. Once rupture occurs, the chance of survival is less than 25 percent. It is estimated that more than one million people are living with undiagnosed AAA, and at least 95 percent of these can be successfully treated if detected before a rupture. Most AAAs do not cause any symptoms, however when present, pain in the abdomen or back is most commonly present. Right Kidney Right Renal Artery Bladder 4 Left Kidney Left Kidney Artery Intrarenal Aneurysm What Causes an Abdominal Aortic Aneurysm? Aortic aneurysms are most often caused by atherosclerosis, a hardening of the arteries that damages the artery’s walls. Over time, excess plaque causes the aorta to stiffen and weaken. Risk factors for aortic aneurysms include: What are Some Symptoms of an Abdominal Aortic Aneurysm? Although you may initially not feel any symptoms with AAA, if you develop symptoms, you may experience one or more of the following: If your aneurysm bursts, you may suddenly feel intense weakness, dizziness, or pain, and you may eventually lose consciousness. This is a life-threatening situation, and you should seek medical attention immediately. • Males 60 and older • Smoking • High blood pressure • High cholesterol • Overweight • Family history of heart disease • A pulsing feeling in your abdomen, similar to a heartbeat • Severe, sudden pain in your abdomen or lower back. If this is the case, your aneurysm may be about to burst • On rare occasions, your feet may develop pain, discoloration, or sores. How is an Abdominal Aortic Aneurysm Diagnosed? AAA can be detected by an abdominal ultrasound that is painless, safe and accurate. Additional tests such as a CT scan, MRI and/or angiography may be recommended. The Center for Aortic Aneurysm Surgery at Central Baptist Hospital recommends early detection screening for those at risk for abdominal aortic aneurysms. For more information about an early detection program for abdominal aortic aneurysm, call 859-260-6326. • Abdominal Ultrasound • CT Scan • MRI • Angiography 5 What is a Thoracic Aortic Aneurysm (TAA)? Thoracic aortic aneurysms (TAA), while not as common as AAA, affect approximately 15,000 people each year. A TAA is an aneurysm that occurs in the chest area and can involve different areas of the upper aorta. Symptoms of TAA vary. Patients can experience chest, abdominal or neck pain, or no pain at all. A TAA may rupture causing a life-threatening situation and the need for immediate medical attention. When detected in time, TAA can often be repaired. Thoracic Aneurysm Heart Right Kidney Right Renal Artery 6 Left Kidney Left Renal Artery Aorta What Causes a Thoracic Aortic Aneurysm? In addition to the risk factors for an AAA, certain diseases can also weaken the layers of the aortic wall and increase the risk of TAA, including: • Marfan syndrome, a genetic connective tissue disorder • Syphilis • Tuberculosis • Rarely, trauma, such as a fall or rapid deceleration in a motor vehicle accident What are Some Symptoms of a Thoracic Aortic Aneurysm? You may not feel any symptoms with TAA. Only half of patients with TAA notice symptoms. If you do have symptoms, they will depend on where your aneurysm is located and how large it is. Possible symptoms include: If your aneurysm is large and in the section of the aorta closest to the heart, it may affect your heart valves and lead to a condition called congestive heart failure. • Pain in the jaw, neck, and upper back • Chest or back pain • Coughing, hoarseness, or difficulty breathing How is a Thoracic Aortic Aneurysm Diagnosed? A TAA is diagnosed by echocardiography, MRI, CT scan and/or angiography. These exams and tests can show the size of the aorta and the exact location of the aneurysm. • Echo Cardiography • MRI • CT Scan • Angiography 7 When Treatment Becomes Necessary, What are my Options? The size of the aneurysm and the overall condition of the patient’s health will determine the need for referral for a surgical evaluation and/or continued monitoring with further screenings. Medical Management Depending on the patient’s health and risk of the aneurysm rupturing, “watchful waiting” may be recommended, with close monitoring of the aneurysm and aggressive management of risk factors, such as high blood pressure. Minimally Invasive Endovascular Aneurysm Repair Endovascular repair is a newer, minimally invasive procedure for the treatment of AAA and TAA and may be an option depending on the location, size and shape of the aneurysm. By making just a small incision in the groin, the surgeon is able to insert a catheter and guide it to the aneurysm using a state-of-the-art 3-D imaging system. An endovascular graft is placed at the site of the aneurysm and creates a new route for blood flow, taking pressure off the aneurysm. The most significant advantage of endovascular repair is that it is minimally invasive, allowing for a faster recovery. In addition, patients who have endovascular repair experience less pain, spend only a few days in the hospital and return to normal activity within 2 to 6 weeks after the procedure. Open Surgical Repair A vascular surgeon may recommend a surgical procedure known as open aneurysm repair to repair an abdominal or thoracic aortic aneurysm. During this procedure, an incision in the chest (for TAA) or abdomen (for AAA) is required. A synthetic graft is placed in the weakened portion of the aorta which seals off the aneurysm. The graft is very strong and allows blood to pass through the aorta without putting pressure on the aneurysm. Following surgery, the hospital stay is usually 5 to 7 days. Depending on how quickly the body heals, it may take 2 to 3 months for a complete recovery. 8 Where do I go For Treatment? Three-year reaccreditation from the Society of Chest Pain Centers, focused on improving care for patients with acute coronary syndromes and related maladies. The Center for Aortic Aneurysm Surgery at Central Baptist Hospital Performing more minimally invasive endovascular aortic aneurysm repairs than any other hospital in Kentucky, Central Baptist Hospital offers the region’s first dedicated Center for Aortic Aneurysm Surgery. Working in state-of-the-art facilities and using some of the most sophisticated technology, our team of surgeons, anesthesiologists, intensive care physicians and nurses, are on the leading edge of diagnosis and treatment. From preventative measures to advance surgical and endovascular repair, we are helping to revolutionize aortic aneurysm repair. For more information regarding aortic aneurysms, please call The Center for Aortic Aneurysm Surgery at Central Baptist Hospital 859-260-6326 American College of Cardiology Foundation for commitment and success in implementing a higher standard of care for heart attack patients. CBH has reached an aggressive goal of treating coronary artery disease patients. A 100 percent success rate of providing intervention in less than 90 minutes to patients with ST-elevation myocardial infarction (STEMI), a condition in which a blocked artery could lead to permanent heart damage. Magnet status designation by the American Nurses Credentialing Center. This national recognition denotes CBH as providing excellence in nursing services and practices. Kentucky Hospital Association’s highest quality honor for leadership and innovation in quality, safety and commitment in patient care. 9 Glossary of Medical Terms Aorta The main artery that carries blood away from the heart to the rest of the body. Abdominal Aortic Aneurysm (AAA) A ballooning (enlarging and thinning) of the aorta due to a weakening in the arterial wall that occurs in the abdomen area. This term is often abbreviated as “AAA.” Aneurysm A ballooning (enlarging and thinning) of a weakened area of a blood vessel. Angiography/Angiogram A method whereby dye is injected into the bloodstream to view blood flow through the blood vessels under X-ray. Uses contrast (dye) and small radiation exposure. The resulting image is an angiogram. Contrast (Dye) A drug injected into the vascular system to show blood flow through the blood vessel on the X-ray image. CT Scan (Computed Tomography Scan) An imaging technique that creates very precise, thin, cross-sectional views of your abdomen and aorta. This technique often uses contrast (dye) and small radiation exposure. Also known as a CAT scan. 10 Endovascular Graft A synthetic graft implanted within a diseased vessel intended to relieve weakened vessel walls without the use of open surgery techniques. An endovascular graft is delivered to the diseased aorta at a small size and then is expanded to the size of the vessel in which it is placed. Endovascular Repair Considered to be less invasive than open surgery, it involves the use of an endovascular graft to seal off an aneurysm inside a diseased aorta, making a new path for blood to flow. Endovascular Treatment The use of guidewires and X-rays taken during an endovascular procedure to treat unhealthy arteries with small incisions in the femoral arteries. MRI (Magnetic Resonance Imaging) A procedure using magnetic fields and radio waves to form an image of structures inside the body. Occlusion The blocking of an artery, causing the stop of normal blood flow. Rupture A tear in the vessel wall near or at the location of the ballooning (enlarging and thinning) of the weakened area of the blood vessel, causing the patient to hemorrhage. 11 1740 Nicholasville Road, Building E Lexington, KY 40503 centralbap.com