Protecting the pipeline

The untimely death of popular actor John Ritter in 2003 brought new attention to a little-understood but often devastating health problem: aortic aneurysm. Tragically, though the condition kills some 15,000 Americans every year, it often escapes diagnosis -- or is mistakenly dismissed as unimportant.

If detected in time, however, aortic aneurysms can be effectively treated, and their potentially fatal complications prevented.

The aorta is the body’s pipeline -- its single largest blood vessel, distributing blood from the heart to every organ and limb. Aortic aneurysms -- bulges in the wall of the aorta -- can lead to deadly ruptures, which disrupt blood flow to major organs. The aorta may also be damaged by a process called dissection, in which its lining shreds abnormally like an onion skin and becomes dangerously weakened.

Despite the aorta’s vital importance, it falls between established medical specialties. Historically, many people with aortic disease tend to drop through the cracks.

Duke’s Center for Aortic Surgery is one of the few interdisciplinary programs devoted to aortic disease nationwide, and it's the premier center in the Carolinas. With specialists from cardiovascular medicine, cardiothoracic and vascular surgery, anesthesiology, and neurophysiology collaborating to approach the disease from multiple angles, the center treats high volumes of patients with aortic disorders.

“Much of our work revolves around identifying candidates for specialized follow-up,” says Duke cardiovascular surgeon G. Chad Hughes, MD. “They might be at risk due to a family history of aortic disease, a related condition such as the Marfan syndrome, or a previously detected aneurysm.”

To accurately identify such at-risk individuals, Hughes and his vascular surgery colleagues work closely with the Duke Cardiovascular Magnetic Resonance Center, where cardiologist Ray Kim is expanding the use of magnetic resonance imaging (MRI) as a diagnostic tool in heart care. MRI is offered in addition to state-of-the-art CT scanning and genetic screening for aortic disease.

Despite its potential seriousness, aortic aneurysm doesn’t always require immediate surgery. According to Hughes, non-surgical treatment may include anti-hypertensives to lower blood pressure, or beta-blockers to slow a rapid heart rate, which is hard on weakened aortic tissues.

The real key, he says, is careful monitoring: “Aneurysms are often diagnosed, but then lost to follow-up.” To prevent that scenario, Hughes follows hundreds of patients with various stages and types of aortic disease each year. “That way, if their condition becomes life threatening, surgical repair can be performed in time,” he says.

If surgery is needed, Hughes and his colleagues offer a full range of the latest techniques. In particular, Duke’s expertise in endovascular repair gives patients a less invasive surgical alternative, especially for those who are ineligible for conventional operations.

So what’s the real bottom line on aortic disease? If you have a family history of aortic illness, have ever been told you have a dilated blood vessel, or have been diagnosed with a heart murmur, Hughes suggests that you have the condition evaluated and followed carefully.

Family history or not, if you ever develop severe chest pain or pain between the shoulder blades, yet an EKG workup shows no evidence of heart attack, seek out an imaging study of your aorta and aortic valve. In this disease as in few others, a picture can truly be worth a thousand words.

Written by Staff for Duke Medicine    |    Added February 6, 2014