The aorta is the body’s largest artery, which carries oxygenated blood from the heart to tissues, organs and the brain. Diseases of the aorta refer to abnormal anatomical parameters, such as an increased diameter or aneurysm, in the presence of serious lesions, such as extensive atherosclerosis, and in particularly acute conditions, such as rupture or separation of the aorta.

Aneurysm

Aneurysm is defined as the presence of dilation of the diameter of the aorta by at least 1.5 times the predicted normal. They can occur in any part of the aorta and are associated with a particularly increased risk of serious complications such as the separation or rupture of the aorta, situations which show a very high mortality and in any case need to be treated in an ultra-emergency phase. Therefore, early diagnosis, before the appearance of complications, can be life-saving for the patient and in this context, the most modern guidelines recommend general diagnostic testing in high-risk groups, such as hypertensive patients, smokers, obese patients, as well as patients with family history. history of aortic disease.

Treatment of aneurysms

Operations to treat aortic aneurysms are among the major operations, with the severity however varying depending on the location and characteristics of the damage. Essentially, the purpose of these operations is to replace the parts of the aorta where the damage is found with the use of appropriate grafts. These operations require significant surgical experience but also the use of new methods that show very satisfactory results.

More specifically, the treatment of aneurysms of the aortic root, which is very often accompanied by aortic valve insufficiency, is of particular interest. The classic surgical treatment consists in replacing the aortic root and the aortic valve using a valvular graft. The major disadvantage of this method is the need for the patient to receive anticoagulant treatment, which is associated with serious complications, for life. To avoid the use of anticoagulation, techniques have been developed to replace the aortic root while preserving the native aortic valve. This particular technique (David’s intervention) shows equivalent, if not better, results compared to the traditional method, both in the short term and in the long term. At the same time, it also has advantages, such as limiting the cases of infective endocarditis to a level that occurs in the general population. This method tends to be the main choice in developed countries, however in our country few surgeons are familiar with such methods.

Another area that is still a challenge for every surgeon is the repair of thoracoabdominal aneurysms. Endovascular techniques have certainly provided reliable solutions for cases of patients who are not suitable due to general health status for extensive open surgical procedures. Nevertheless, the long-term results are not equivalent to those of the complete replacement of the diseased aorta, while complications, such as endoleak, are often observed, which require new interventions. From this point of view, open surgical procedures still maintain the main treatment with constantly improving results and in any case should be preferred in patients with good general condition.

The cases of aortic diseases have been steadily increasing in recent years, a fact related to the aging of the population, lifestyle and the improvement of diagnostic techniques.

The surgical treatment of aortic diseases is associated with very satisfactory results, it should be done without delay when indicated and the new methods offer possibilities for further improvement of the quality of life after the operation.