Oregon Health & Science University
  • Kevin G. Billingsley, M.D. Cherrie Abraham, M.D.
    Director, Aortic Program
    OHSU Knight Cardiovascular Institute
    Cherrie Abraham, M.D., recently joined the OHSU Knight Cardiovascular Institute as director of the Aortic Program. He was previously on the faculty of McGill University in Montreal, Canada. Dr. Abraham is internationally known as a key opinion leader in the endovascular treatment of aortic aneurysms and dissections. In 2009, he performed the world’s first total endovascular repair of an aortic arch aneurysm. He joins the OHSU Division of Vascular and Endovascular Surgery, already known locally and regionally for their ability to treat difficult vascular pathology.
    OHSU Knight Cardiovascular Institute

Help for patients with aortic disease

Aortic aneurysm and dissection account for significant morbidity and mortality worldwide. The incidence of aortic diseases is expected to rise with the increasing age of the population.

Evaluating and diagnosing aortic problems

If you suspect an aortic condition, we recommend thorough evaluation of the patient by one of our aortic team members and investigation with chest and abdominal CT angiography.

Aortic conditions
Aortic conditions include:

  • Aortic aneurysms – These can affect any anatomic location, including the ascending aorta, aortic arch and thoracic, thoracoabdominal and abdominal aorta.
  • Acute aortic dissections – Also called type A or type B aortic dissections. These may be surgical emergencies. Patients should be referred immediately to a center with cardiac and vascular surgical experience in treating aortic dissections.
    • Patients with type A dissections require urgent operation.
    • Patients with type B dissections may often be managed medically with aggressive blood pressure control in a monitored intensive care setting. Surgery, often endovascular repair, is sometimes required in the acute setting for end-organ ischemia or rupture.
  • Chronic aortic dissections – These patients require careful evaluation and follow-up. The dissected aortas are prone to dilatation and may become aneurysmal. We recommend serial follow-up with CT or MRI, initially at short intervals, and tight blood pressure control.
  • Infections of the aorta– Mycotic infections are serious and challenging. An aortic specialist should assess these patients. They are especially likely to benefit from our adult congenital aortic specialist assessment in our multidisciplinary program.

Some aortic conditions are congenital or associated with genetic syndromes such as Marfan, Turner, Loeys-Dietz and Ehlers-Danlos. Patients with these conditions often present with aortic dissections or aneurysms. They are especially likely to benefit from specialist assessment in a multidisciplinary program.

Risk factors, symptoms and signs in primary care

Aortic disease risk factors
Smoking, systemic hypertension and a family history of aortic disease are important risk factors. Patients with two of these three risk factors should be screened for abdominal aortic aneurysm, usually with an abdominal ultrasound.

Red-flag symptoms and signs
The following should prompt an evaluation for aortic disease:

  • Chest pain – May be back, flank, mid-scapular or abdominal pain. A cardiac cause of the pain must be ruled out.
  • Pulsating abdominal mass or abdominal imaging suggesting abdominal aortic enlargement.
  • Abnormal chest X-ray, CT scan or echocardiogram suggestive of thoracic aortic enlargement.
  • Different blood pressure between right and left arms.

Treatment options for aortic disease

Because of the life-threatening nature of aortic conditions, consultation with an aortic disease specialist is strongly recommended. The aortic program at OHSU provides multidisciplinary care for all types of aortic conditions. We aim to offer the most appropriate treatment for the patient and their anatomy.

Open repair of thoracic and abdominal aneurysms
In open aneurysm repair, a synthetic graft is sutured to the aorta to replace the aneurysm. This is an invasive operation, often requiring a short stay in the cardiovascular intensive care unit. Patients who are not anatomically suited for endovascular aneurysm repair are often best served with conventional open repair. The aortic specialists at OHSU Knight Cardiovascular Institute are highly experienced in difficult open aneurysm repairs and serve as a regional resource for this care.

Endovascular aortic aneurysm repair
Endovascular aneurysm repair, or EVAR, is a minimally invasive procedure with shorter operative times, reduced length of stay and fewer complications than open surgery. Endovascular procedures are becoming the most common treatment for aortic aneurysms. However, a patient’s anatomy and condition must be appropriate for EVAR.

Thoracic endovascular aortic aneurysm repair
Endovascular repair is now the preferred option for repair of thoracic aortic aneurysms. However, some thoracic and thoraco-abdominal aneurysms may be better treated by conventional open surgery. An aortic disease specialist will review the imaging studies and discuss treatment options with you and your patient.

Advanced technology for aortic repair
The OHSU Knight Cardiovascular Institute has specialized cardiovascular operating rooms with sophisticated imaging capabilities. OHSU is a Magnet hospital with a specialized cardiovascular ICU. This unit is staffed 24/7 with experts in cardiovascular and aortic critical care. The Aortic Program at OHSU is your regional resource to help manage patients with aortic conditions. We collaborate with providers around the region to care for patients with all types of aortic conditions. We are available to discuss advantages and disadvantages of endovascular vs. open aortic surgery with you and your patient. Follow-up is offered at OHSU or in the patient’s home community.

Contact us

The aortic disease specialists at the OHSU Knight Cardiovascular Institute are always available to consult with you. To refer a patient or consult with our team, call the OHSU Physician Consult & Referral Service at 800 245-6478 and ask to speak to the vascular or cardiac surgeon on call.

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