Mount Sinai's vascular surgeons have extensive experience in the diagnosis and treatment of anurismal disease. Experts in minimally invasive procedures and traditional open surgery, our distinguished team offers the most advanced treatments for each patient, and personalizes a treatment plan tailored to his or her condition and life style.
An aneurysm occurs when the walls of an artery becomes weak. The pressure of blood flow can cause the artery to stretch like a balloon into an aneurysm. Aneurysms can develop anywhere along the length of the aorta. The majority, however, are located along the abdominal aorta. These are known as abdominal aortic aneurysms (AAA's) which are relatively common, but could pose significant risks.
Abdominal Aortic Aneurysms
Abdominal Aortic Aneurysms (AAA's) vary in size. Once an AAA develops, it tends to gradually get larger. Surgery isn't usually advised for the treatment of small AAA's, but our surgeons will need to monitor you closely to see if your AAA grows over time. Our physicians will likely recommend changes in lifestyle -- including quitting smoking and incorporating a good diet and exercise into your daily routine. Surgery for AAA may be advised if your aneurysm is larger than 5 cm, causing pain, or if you have a family history of ruptured aneurysm.
Aneurysm Surgery and Procedures
The Surgeons at Mount Sinai offer both open and minimally invasive techniques to patients with aneurismal disease. Open surgery for aneurysm repair involves an incision in the abdomen to replace the affected section of vessel with a fabric-like graft. The risk of later complications is low once the patient recovers from a successful operation. For patients who are candidates, the vascular surgeons at Mount Sinai use minimally invasive techniques to repair aneurysms. The aneurysm can be safely repaired using these techniques and allows the patient to recover faster and minimize pain.
Stent Graft Insertion
With modern technology, the risks of surgical aneurysm repair can be markedly reduced by endovascular stent grafting. This minimally invasive procedure, known as Endovascular Aneurysm Repair (EVAR), allows the graft (which is mounted on a metal scaffold called a stent) to be placed within the aorta. During the procedure, the graft is into the aorta through small incisions in the arteries of the groin and positioned using X-rays.
Not every patient or every aneurysm is suitable for this procedure. In particular, aneurysms arising close to or above the kidneys are more difficult to treat in this way. All patients treated with endovascular surgery at Mount Sinai need to be followed up postoperatively with regular surveillance scans of the stent-graft. EVAR has a quicker recovery time because it does not involve making large surgical incisions. There are fewer complications when a stent graft is used to repair an aneurysm
Thoracic Aortic Aneurysm
The thoracic aorta is the largest artery in the body. It originates at the aortic valve and passes through the chest towards the abdomen, branching off to the head and upper extremities along the way. An aneurysm occurs when the walls of the artery weaken as a result of disease or trauma. This weakening of the artery can develop over many years and go undetected. Aneurysms are typically asymptomatic until they rupture. A tear or rupture of a thoracic aortic aneurysm can cause life-threatening internal bleeding.
Treatment of Thoracic Aortic Aneurysm
Because the aorta is made up of multiple parts, (the ascending aorta, aortic arch, and descending aorta), treatment for an aneurysm is dependent upon the exact location and size. If the aneurysm is not causing any symptoms and is small in size, your Mount Sinai vascular surgeon may monitor the vessel to watch for growth and changes. If the aneurysm is causing symptoms and has grown, your doctor may recommend a surgical intervention.
The surgeons at Mount Sinai recommend repairing the aorta when the aneurysm grows to a specific size (typically 5 or 5.5 centimeters in diameter in the thoracic aorta). For aneurysms located in the descending thoracic aorta, our surgeons may recommend endovascular stent grafting (TEVAR), a minimally invasive technique that may be used to repair the aneurysm. For patients who are not a candidate for TEVAR, a more invasive operation that replaces the aorta with a fabric graft may be suggested. The choice of therapy -- endovascular stent graft repair or traditional open repair -- depends on a number of factors, including the patient's overall health, anatomic considerations, and patient preference.
Aneurysm of other Blood Vessels
Aneurysms can occur in other vessels in the body such as arteries of the legs or vessels that circulate blood to the intestines and abdominal organs. These aneurysms may fill with clots that interrupt blood flow and have the potential to rupture, causing life threatening bleeding. Rupture can be avoided by removing the aneurysm and restoring circulation with bypass surgery (open surgery) or with minimally invasive procedures. In the open procedure, the diseased aneurysmal segment of the blood vessel is replaced with either a vein graft of a fabric bypass.
Minimally invasive procedures are often used to treat aneurysms at Mount Sinai, instead of traditional open surgery. These minimally invasive treatments may employ a stent or stent graft to reinforce the dilated wall of the artery, preventing rupture and allowing blood to flow freely. In other circumstances, the aneurysm itself is closed down using material introduced through a catheter. This procedure stops the blood from circulating into the aneurysm, thereby preventing rupture.
Division of Vascular Surgery
5 East 98th Street, 3rd Floor
New York, NY 10029