Aortic artery surgery

The aorta is the largest artery in the body: it carries blood from the heart and extends downwards through the abdomen. Aortic surgery is performed to repair an enlarged aorta (aortic aneurysm), for aortoiliac occlusive disease and for conditions of the aortic valve. The main interventions are open aneurysm repair, aortic endarterectomy and aorto-bifemoral bypass.

Aortic artery surgery at a glance

• Conditions treated: aortic aneurysm, aortoiliac occlusive disease (Leriche syndrome), aortic atherosclerotic plaque
• Interventions: open aneurysm repair, aortic endarterectomy, aorto-bifemoral bypass
• Minimally invasive alternative: EVAR stent-grafting, in cases with favourable anatomy
• What is at stake: preventing aneurysm rupture and saving the lower limbs

What is the aorta and why does it matter?

The aorta is the largest artery in the body: it starts from the lower left chamber of the heart (the left ventricle) and descends through the chest and abdomen, distributing oxygenated blood to the whole body. Between the aorta and the heart lies the aortic valve, which opens to allow the blood flow out of the heart, then closes to prevent the blood from flowing back.

Aortic surgery is performed to repair an enlarged aorta (aortic aneurysm), the aortic valve and the aortic valve openings, as well as to replace aortic valves.

Open aortic aneurysm repair

An aortic aneurysm is a condition characterised by an abnormal ballooning or bulging of a section of the aorta, due to the weakness of the blood vessel wall. An aneurysm can develop anywhere along the course of the aorta.

How does the intervention work?

Open surgery is the most frequent type of surgical intervention for repairing an aortic aneurysm, but also the most invasive — it involves opening the cavity to reach the vessel. The surgeon replaces the weakened section of the aorta with a tube, called a “graft”, made of a special, resistant fabric. Once the graft is in place, blood pressure no longer acts on the weakened wall, and the risk of rupture is eliminated.

For patients with favourable anatomy and increased surgical risk, there is also the minimally invasive variant — EVAR stent-grafting.

Aortic endarterectomy

Endarterectomy is performed to remove the plaque located inside an artery — the fatty, waxy deposit that slowly builds up in the arteries over time, thickening their walls and narrowing their lumen.

Aortic endarterectomy is a less frequently used approach and is suitable in selected cases, for example for aortic decalcification during aortic valve replacement (AVR).

Aorto-bifemoral bypass

Aorto-bifemoral bypass is the operation for revascularising and restoring the arterial flow to both lower limbs. Through this intervention, both legs can be saved from gangrene (irreversible ischaemia).

Indications: Leriche syndrome

The operation is indicated in several clinical situations, but the most frequent is Leriche syndrome — aortoiliac occlusive disease. This is the obstruction of the blood flow from the abdominal aorta towards the lower limbs, produced by the clogging of the arteries with fat deposited on their inner walls.

What is at stake is major: most patients with this syndrome, left untreated, end up with bilateral thigh amputation, and the extension of the gangrene to the thigh and hip can also lead to death.

The technique

Through the bypass, in order to get around the narrowed or blocked blood vessel, the blood is redirected through a synthetic graft, connected from the aorta to both femoral arteries — hence the name “bi-femoral”.

Frequently asked questions

What symptoms does an abdominal aortic aneurysm cause?

Often none, until it reaches a large size. Abdominal or back pain and a pulsating sensation in the umbilical area can appear. A rupture of the aneurysm causes intense pain, low blood pressure and a rapid pulse — a major medical emergency. This is why aneurysms that are discovered are monitored with periodic imaging.

What is Leriche syndrome?

Aortoiliac occlusive disease — the obstruction of the blood flow from the abdominal aorta towards the legs. It shows itself through claudication in the thighs and buttocks, absent femoral pulses and, in men, erectile dysfunction. Untreated, the risk is bilateral amputation.

Open surgery or EVAR?

It depends on the anatomy of the aneurysm and on the patient’s risk: EVAR avoids opening the abdomen and has a faster recovery, but is not suitable for every case. The decision is taken after a complete imaging evaluation.

How long does an aortic graft last?

Modern synthetic grafts are designed for long-term durability. Periodic imaging check-ups, established by the doctor, verify how the graft is working and the condition of the surrounding vessels.