Aortic Conditions

Abdominal Aortic Aneurysm (AAA)

An abdominal aortic aneurysm is when the abdominal aorta enlarges to more than 1.5x the normal size. As the aorta enlarges the weakened walls may put the patient at risk of rupture. At small sizes the aneursym is usually monitored closely, but as the size of the aneursym reaches 5cm in diameter repair will usually be recommended to prevent the risk of rupture. 

Dr Vivienne Moult is skilled in all types of aneurysm repair, including endovascular (keyhole) repair. Dr Moult will perform a thorough assessment and consultation and then discuss with you about your aneurysm, before making a recommendation on the best type of repair for you. 

Endovascular Aneurysm Repair (EVAR) 

Endovascular repair is a minimally invasive method of aneurysm repair which involves placing a stent inside the aneurysm to seal off the damaged section of blood vessel, so that the blood no longer flows through the aneurysm putting pressure on the walls and risking rupture. Patients usually have a hospital stay of 2 nights and recover quickly after this type of repair. Ongoing regular surveillance is required after the repair to ensure that it continues to seal off the aneurysm. 

Not all aneurysms are anatomically suitable for endovascular repair. Dr Vivienne Moult will be able to discuss with you regarding your aneurysm and whether or not it is suitable. There are many types of new technologies and grafts that are now available for aneurysms that would not be suitable for a standard EVAR graft - Dr Moult can discuss with you whether various other types of endovascular repair might be suitable instead such as a FEVAR (fenestrated endovascular aortic repair). 

Open Aneursym (AAA) Repair

Open surgery involves replacing the aneurysmal section of aorta with a graft. This is through a large cut in the abdomen (laparotomy). Open repairs do not typically require the lifelong surveillance that endovascular repairs, and whilst they take longer to recover initially they are a good longterm durable repair. An open repair may be recommended depending on the anatomy of your aneurysm, or taking into account other factors such as young patient age, distance for ongoing follow-up and of course patient preference. 

Aortoiliac Aneursyms

Sometimes people suffer from aneurysms affecting other arteries instead or in addition to the adbominal aortic aneursym (AAA). In some people the illiac arteries may also become aneurysmal, known as an aortoiliac aneurysm. Iliac aneurysms are often treated at the same time as the aortic repair, and may affect the type of repair that is performed. There are open, endovascular and hybrid methods for treating these aneurysms depending on the anatomy and features of the aneurysm. Dr Vivienne Moult will perform a thorough assessment and can discuss all of the options with you at the consultation. 

Other Aneursyms

Aneurysms may also affect other arteries such as the renal arteries (to the kidneys), splenic artery (to the spleen), popliteal artery (behind the knee) or in fact any artery in the body. Dr Vivienne Moult specialises in treating aneurysms and can discuss with you regarding your aneurysm, the risks and management options. Rest assurred that surgery is not alway neccessary, and Dr Vivienne Moult will only proceeding to surgery (both open or keyhole) if absolutely neccessary. Many aneurysms can safely be monitored closely whilst under the threshold size for repair. 

Thoracic Aortic Disease 

Aortic Dissection 

The aorta may suffer from a dissection which is essentially a tear in the inner wall of the aorta. This is a very serious condition that requires emergent hospitalisation and management. Management typically consists of very intensive medical therapy and blood pressure lowering and in some cases patient’s may also require repair with a stent, also known as a TEVAR (Thoracic endovascular aortic repair). Over time the tear in the wall of the aorta will stabilise or resolve. If the tear does not resolve completely, then it will require ongoing monitoring as there is a risk of long term aneurysm formation due to weakening of the aortic wall. Aneurysms are when a section of diseased artery expands more than 1.5x the normal diameter, and as the size of the aneurysm increases, this weakening of the aortic wall risks rupture which is a serious and life-threatening complication. 

Repair may be recommended if your aortic diameter becomes aneurysmal. Repairs are typically very complex and require care consideration, discussion and planning. Dr Vivienne Moult is able to carefully assess and monitor your situation and will discuss amongst a multi-disciplinary team of specialists should you require repair to ensure you get the best possible care. 

Acute Aortic syndromes 

This is a group of conditions that result from damage to the aorta (which is the major blood vessel in the body). Conditions include aortic dissection (detailed above), penatrating aortic ulcer (PAU) and intramural haematoma (IMH). All of these conditions result from varying degrees of a tear or damage to the aortic wall. 

Traumatic Aortic Injuries 

A traumatic aortic injury most often occurs as a result of major trauma. Damage to the aortic wall can result in a tear in the inner lining of the aorta, or may be severe enough to lead to an acute dissection, intramural haematoma or rupture. Treatment is emergent and as for aortic dissection (above) involves intensive medical therapy and may also require a endovascular stent or TEVAR.