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

2. Anatomy - Aorta

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

4. Aortic Aneurysm – Types / Location

5. Aortic Aneurysm – Types / Shape

6. Aortic Aneurysm - Video

7. Aortic Aneurysm - Video

8. 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.

9. 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

10. 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

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

12. 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)

13. Marfan Syndrome

14. 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

15. Albert Einstein –
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

16. Albert Einstein –
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.

17. Albert Einstein –
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.

18. Albert Einstein –
“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.”

19. Modern Day Repair Techniques
Open Technique
Endovascular Technique

20. Open AAA Repair

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

22. Aortic Aneurysms
Thoracic and Abdominal - Video

23. Open AAA Repair - Video

24. Endovascular AAA Repair

25. Endovascular AAA Repair

26. Endovascular AAA Repair

27. Endovascular AAA Repair - Biomaterials
ePTFE
Nitinol Stent
Dacron
Nitinol Stent

28. Endovascular Aortic Vessel Repair
- Video

29. Endovascular Thoracic Aortic Repair
- Video

30. Endovascular Abdominal Aortic
Repair - Video

31. T/AAA and Ruptured AAA Story

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