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What you need to know about aortic aneurysms and dissections

Derek Brinster, MD, discussions cardiac matters with a female patient.
Derek Brinster, MD, (center): Understanding these serious conditions are the first step.

A tear or blockage in your aorta can be life-threatening. Learn what you should do if these conditions emerge

As the largest artery in the body, the aorta has a significant responsibility to channel blood flow to and from the heart. So when aortic disease arises, the artery can tear (dissection) or bulge (aneurysm), presenting a serious and often emergent situation.

This can be a life-threatening condition for hundreds of thousands of people in the US. And despite tremendous progress in advancing diagnosis and treatment, many are still at risk.

Aortic dissections

An aortic dissection is a tear that separates the inner and middle layers of the body’s largest artery, causing extreme blood loss, leaving other organs and the rest of the body in jeopardy.

There are two types of dissection:

  1. Ascending aortic dissection is the most dangerous type of dissection and develops closest to the heart. It can cause a multitude of issues such as stroke, heart attack and heart failure. This is a surgical emergency, given if left untreated 50 percent of patients die within 48 hours.
  2. Descending aortic dissection happens on the descending part of the artery and can be quite large. Nearly 10 percent of these require an interventional procedure during initial hospitalization.

To deliver the best care for these critical conditions, surgical programs across the world have teamed up to share information and best practices. Northwell Health is the only cardiac program in New York City to participate in a global network called the International Registry of Acute Aortic Dissection (IRAD), which has helped improve survival by making the latest research, articles and outcomes of nearly 9,000 patients from 55 participating institutions available in an online database.

Aortic dissections are our expertise and IRAD lists the health system as the second-ranked health system in the world for surgical enrollment and ninth for combined medical and surgical cohorts.

Aortic aneurysms

Aortic aneurysms are abnormal bulges that can happen anywhere inside the wall of the aorta. There are two forms — abdominal aortic aneurysm (AAA) or thoracic aortic aneurysm — both of which can pose a significant threat.

The general guide is that any aortic aneurysm four centimeters in size or greater requires frequent monitoring with appropriate adjustments to lifestyle to improve cardiovascular health.

Similar to how IRAD monitors and shares best practices and patient outcomes, Northwell maintains a unique internal registry that helps track and monitor all aortic aneurysm patients regardless of the hospital where they initially receive care. For example, someone who presents with an aortic aneurysm at Southside Hospital may be monitored by the health system’s expansive network, allowing clinicians to observe the aneurysm’s size and provides reminders for follow up that is near the patient’s home. Using this tool, our surgeons are able to closely follow patients so that appropriate interventions can be made before a life-threatening rupture occurs.

Advancements in aortic care

Aortic surgery is necessary to help people at their most dire times. Minutes can count with these severe conditions.

Corrective techniques have improved significantly throughout the years. For example, removing the aneurysm via minimally invasive techniques requires small keyhole-sized incisions. This reduces blood loss and morbidity while allowing patients to get on their feet quicker. Another minimally invasive approach is endovascular aortic repair, which uses stents and catheters to remove the aneurysm.

Perhaps the biggest advancement for those suffering aortic disease has been improved and seamless transitions in care. For example, Northwell’s Aortic Transfer Center is a centralized call center that utilizes a direct priority transfer algorithm, along with a high-tech ambulance/helicopter location system to yield rapid transfers to a hospital with adequate services. This program immediately bypasses any delays, transferring you to the right hospital that is open and ready. It is a life-saver when time is most critical.

Derek Brinster, MD, is director of aortic disease at Northwell Health, one of the highest-volume aortic centers in North America, especially for aortic dissections. He is also a professor at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell.

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