The aorta is the largest blood vessel in the human body, originating from the heart’s left ventricle and distributing oxygen-rich blood to the entire systemic circulation. It extends upward, arches over the heart, and then travels downward through the chest and abdomen before splitting into the arteries that supply the legs. Aortic surgery is a medical procedure designed to repair or replace a damaged segment of this major vessel, often involving the insertion of an artificial tube, known as a synthetic graft. The structural integrity of the aorta is paramount, and any compromise to its wall can put the body’s entire blood supply at risk, making surgical intervention a necessity.
Conditions That Require Aortic Surgery
Aortic surgery is typically required to address two main structural failures of the vessel wall: an aortic aneurysm or an aortic dissection. An aortic aneurysm occurs when a localized area of the aortic wall weakens, causing the vessel to balloon outward. These aneurysms can occur anywhere along the aorta’s length, though three-fourths of them develop in the abdominal section. Aneurysms are dangerous because the continuous pressure of blood flow against the thinned wall increases the risk of rupture, which leads to catastrophic internal bleeding.
An aortic dissection involves a tear in the innermost layer of the aortic wall, called the intima. Blood then rushes through this tear and pushes between the inner and middle layers, separating them and creating a new, false channel within the artery. This separation can rapidly reduce blood flow to major organs branching off the aorta, leading to a sudden, life-threatening emergency often described as a tearing or ripping pain. The decision to operate is generally based on the size of an aneurysm—typically when it reaches 5.0 to 5.5 centimeters—or immediately upon diagnosis of an acute dissection.
Open Repair Versus Endovascular Repair
The two primary methods for addressing aortic pathology are traditional open repair and minimally invasive endovascular repair.
Open Aortic Repair
Open aortic repair involves a large incision in the chest or abdomen to directly access the damaged section of the aorta. The surgeon temporarily clamps the aorta to stop blood flow, removes the compromised segment, and then stitches a synthetic fabric graft into place to restore the vessel’s continuity. This approach is highly effective and is often the preferred method for younger patients or those with complex aortic anatomy, such as when the aneurysm is near major branch arteries.
Endovascular Aortic Repair (EVAR/TEVAR)
Endovascular Aortic Repair, or EVAR (or TEVAR for the thoracic aorta), offers a less invasive alternative. This technique involves making small incisions in the groin and threading thin catheters through the femoral arteries up to the damaged aortic segment. A stent-graft—a fabric tube supported by a metal mesh frame—is then deployed inside the aorta, relining the vessel and diverting blood flow away from the diseased wall. EVAR is favored for patients with a higher risk profile for major surgery, as it significantly reduces blood loss and trauma to surrounding tissues.
The choice between the two methods depends on the patient’s overall health and the specific location and shape of the aortic damage. While open surgery provides a more durable, long-term fix, endovascular repair is quicker to perform and associated with a shorter hospital stay. EVAR requires the patient’s aorta to have a suitable anatomy, particularly a healthy segment above and below the aneurysm to ensure the stent-graft can seal properly. Patients who undergo endovascular repair also require regular imaging surveillance to ensure the stent-graft remains correctly positioned and functioning over time.
Navigating the Recovery Period
The recovery experience differs significantly depending on whether a patient undergoes open or endovascular repair.
Recovery After Open Repair
Following open aortic surgery, patients typically spend one to three days in the Intensive Care Unit for close monitoring before moving to a standard hospital room for a total hospital stay of about four to seven days. The extensive nature of the incision means the initial recovery period is marked by significant pain, and the full return to normal activity can take up to three months. Patients are advised to avoid lifting anything heavier than 10 pounds for six to twelve weeks to allow the incision to heal completely.
Recovery After Endovascular Repair
In contrast, endovascular repair is associated with a much faster recovery trajectory due to the smaller incisions and reduced surgical trauma. Patients often spend only one night in the Intensive Care Unit and are discharged from the hospital within one to two days. Most individuals can resume light daily activities, such as walking, within a week of the procedure. Doctors advise against heavy lifting or strenuous exercise for two to four weeks to ensure the integrity of the puncture sites and the newly placed stent-graft.