Aortic Vessel Repair Jeffrey R. Scott, Ph.D.

Anatomy - Aorta

Definition Aneurysm A localized enlargement or dilation of a blood vessel (~1.5X the normal diameter) caused by weakening of the vessel wall.

Aortic Aneurysm – Types / Location

Aortic Aneurysm – Types / Shape

Aortic Aneurysm - Video

Aortic Aneurysm - Video

Abdominal Aortic Aneurysm (AAA) - Scope of the Problem 200,000 people in the U.S. are diagnosed with AAA per year. Over 15,000 people in the U.S. die per year from ruptures. AAAs are the tenth leading cause of death in men over 50. An estimated 1 million men and women worldwide are living with undiagnosed AAA.

Abdominal Aortic Aneurysm (AAA) - Facts - Male:Female Ratio = 10:1 - More prevalent with age (>70) - Infra renal abdominal aorta most common - Fusiform shape most common - May involve iliac arteries

Risk Related to Aneurysm Diameter Abdominal Aortic Aneurysm (AAA) - Risk of Rupture LaPlace’s Law T = Pr T = aortic wall tension P = blood pressure r = radius of aorta Risk Related to Aneurysm Diameter 55 mm = 5% per year 60 mm = 10% per year 70 mm = 20% per year

Abdominal Aortic Aneurysm (AAA) - Rupture Mortality - If blood is outside of the aortic lumen mortality = 80% - If patient arrives at hospital mortality = 50%

Etiology of Disease / Risk Factors True Aneurysm (Fusiform – Radial Expansion) Degeneration of the Aortic wall (weakening) over time - Hypertension - Turbulent Flow Patterns - Smoking - Advanced Atherosclerosis - Age Traumatic Event Rapid degeneration of the Aortic wall (weakening) over time - Accelerated with collagen degenerative disorders such as, Marfan Syndrome Dissecting Aneurysm (tear through the media)

Marfan Syndrome

Aneurysm Diagnosis Physical Examination - Pulsatile Mass - Chest (TAA) or Back (AAA) Pain Ultrasound - Incidental Observation Ongoing Screening (Size) CT Scan / Angiogram Confirmatory Diagnosis Size Appropriately Additional Anatomical Detail Plan Repair Approach

Albert Einstein – 1879 - 1955 1949 Laparotomy was conducted for suspected gallbladder problems at Brooklyn Jewish Hospital Large AAA found instead “…the aneurysm was very large. I can remember the yellow color of the cellophane that was used to wrap the anterior 2/3rds of the aneurysm. Mobilization of the posterior aorta was considered too dangerous at the time.” - Ira Teicher, MD

Albert Einstein – 1879 - 1955 Discharged three weeks later on January 13, 1949 and took a six week Florida vacation. Returned to work at the end of February 1949. Cellophane wrap prevented rupture for 6 years.

Albert Einstein – 1879 - 1955 1955 Seen at home by physician on April 13th, 1955 with “vague lower abdominal and back discomfort”. Diagnosed as chronic cholecystitis. Pain worsened on the 14th and physician noted “the pulsating aneurysm had enlarged markedly since the abdominal examination three months earlier”. Died on April 18, 1955 of a ruptured AAA at the hospital.

Albert Einstein – 1879 - 1955 “I want to go when I want. It is tasteless to prolong life artificially. I have done my share, it is time to go. I will do it elegantly.”

Modern Day Repair Techniques Open Technique Endovascular Technique

Open AAA Repair

Open AAA Repair - Biomaterials Polyethylene Terephthalate (Dacron) Aortic Graft ePTFE Aortic Graft

Aortic Aneurysms Thoracic and Abdominal - Video

Open AAA Repair - Video

Endovascular AAA Repair

Endovascular AAA Repair

Endovascular AAA Repair

Endovascular AAA Repair - Biomaterials ePTFE Nitinol Stent Dacron Nitinol Stent

Endovascular Aortic Vessel Repair - Video

Endovascular Thoracic Aortic Repair - Video

Endovascular Abdominal Aortic Repair - Video

T/AAA and Ruptured AAA Story

Aortic Vessel Repair Jeffrey R. Scott, Ph.D.