Aortic Disease & Aneurysm

The aorta is the largest artery; it leaves the heart and distributes blood to the body, running through the chest and abdomen. When the aortic wall weakens, the vessel can bulge like a balloon; this is called an aneurysm. Aneurysms grow slowly, often cause no symptoms and can be life-threatening if they rupture.

Smoking, high blood pressure, atherosclerosis, older age, male sex and a family history of aortic aneurysm are the main risk factors. Abdominal or chest pain, back pain or a pulsating mass in the abdomen can be symptoms; often it is found incidentally on imaging done for other reasons.

In aortic dissection the inner layer of the vessel tears and blood enters between the layers of the wall. A pseudoaneurysm is a sac of blood formed in the surrounding tissue after the vessel wall is injured. Penetrating ulcers and traumatic aortic injury can also need urgent treatment. Some of these are grouped under “acute thoracic aortic syndrome” and are emergencies.

In endovascular repair (EVAR/TEVAR) a catheter inserted through the groin arteries carries a fabric-covered tube (stent graft), folded, to the aneurysm. When the graft opens it directs blood through the graft instead of through the aneurysm sac, lowering pressure on the aneurysm wall and the risk of rupture.

In complex anatomy where branches of the aorta (kidney, bowel, neck arteries) must be preserved, special techniques such as parallel grafts (chimney/periscope), branched or fenestrated grafts can be used.

Suitability is determined by assessing vessel diameter, length and angulation on CT angiography. Not every aneurysm is suitable for the endovascular method; in that case open surgery or close surveillance comes into question.

In a 2016 study in which Prof. Dr. Murat Canyiğit is among the authors, 31 patients treated endovascularly for acute thoracic aortic syndrome had 100% procedural success and 9.7% in-hospital mortality. The team has also reported use of parallel grafts for a ruptured aortic arch pseudoaneurysm (2019), retrieval of a broken stent-graft tip with a coaxial technique (2019), an iliorenal periscope graft (2015) and a method to reduce the contrast load during endovascular aortic repair (2013).

With the endovascular method the hospital stay is usually shorter than with open surgery. After the graft is placed, regular follow-up with CT or ultrasound is essential to look for leaks, graft migration or new narrowing. Blood pressure control, quitting smoking and medication are part of follow-up.

Risks include access-site complications, kidney effects, endoleak (blood leaking around the graft), graft infection, need for further intervention and, rarely, stroke or spinal cord ischemia.

If a small aneurysm has been found there is no need to panic; many aneurysms are monitored for years. What matters is not skipping CT or ultrasound checks at the recommended intervals, keeping blood pressure at target and quitting smoking. Because aortic aneurysm and dissection can run in families, relatives are advised to ask their doctor about screening.

Ask your doctor about heavy lifting, straining and the use of certain antibiotic groups. If sudden severe chest, back or abdominal pain starts, call 112 without waiting.

At the first consultation your complaints, medical history, medications (especially blood thinners and diabetes drugs), allergies and previous imaging and test results are reviewed together. Change in aortic diameter over time, blood pressure and heart-kidney disease, smoking history and family history of aneurysm are asked about. Please bring previous reports, films and CDs, your current medication list and any blood test results.

If needed, additional imaging or tests are requested. Whether the treatment is suitable, how the procedure will be done, the possible risks and the alternatives are explained in detail; your questions are answered and the procedure is planned after your consent is obtained.

Preparation instructions are given according to the type of procedure and the patient's condition. In general this involves fasting for a set time before the procedure, having tests that show kidney function and bleeding-clotting values and adjusting some medications as advised by the doctor. Always tell us if you are allergic to contrast material or medicines.

Having a relative with you on the day of the procedure is helpful for returning home after discharge.

Consultations and procedures are carried out in person at Ankara City Hospital, Neuro-orthopedics Building, Department of Radiology, Interventional Radiology Unit; online consultation is not offered. Appointments can be made on DoktorTakvimi via the Book button or by phone at 0850 333 0388. See the Contact page for the address and directions.