Expert Treatment of Aortic Occlusive Disease

What Causes Aortic Occlusive Disease?

A number of health conditions can cause aortic occlusions, including:

• Atherosclerosis (buildup of plaque in the inner lining of an artery)
• Aortic dissection
• Coarctation: a narrowing of a short section of the aorta that occurs as a birth defect
• Swelling caused by inflammatory conditions such as Takayasu arteritis

Causes and & Risk Factors for Aortic Occlusive Disease

The most common cause of aortic occlusive disease is atherosclerosis. Often referred to as the hardening of the arteries, atherosclerosis is the gradual buildup of plaque in arteries throughout the body. As atherosclerosis progresses, plaque can completely block the aorta or a blood clot can become lodged in the plaque-narrowed section. Risk factor for developing atherosclerosis include:

• Smoking
• Diabetes
• High blood pressure
• High cholesterol or a high fat diet (or both)
• Age over 60
• Family history of atherosclerosis

Symptoms of Aortic Occlusive Disease

Symptoms of aortic occlusive disease are dependent on the severity of the blockage and its location in the aorta. The more restricted blood flow gets as a result of the blockage, the more symptoms will worsen. Symptoms may present quickly and be so severe that urgent medical treatment is required. Other times, symptoms are mild enough that further diagnostic tests can be conducted to find the cause of the disease before your doctor determines a course of treatment.

Symptoms of aortic occlusive disease may include:

• Dizziness
• Fainting
• High blood pressure
• Pain, fatigue, numbness in the arms
• Pain, fatigue, numbness in the legs
• Stroke
• Transient ischemic attack (a temporary blockage of blood flow to the brain)
• Abdominal pain after eating leading to weight loss
• Erectile dysfunction in men

How Is Aortic Occlusive Disease Treated?

If your aortic occlusive disease is caused by blood clot, we may treat it with a procedure called thrombolysis, which is a catheter-directed therapy in which a clot-dissolving drug is infused into the clot over a period of several days. Thrombolysis restores blood flow through the blocked artery without the need for invasive surgery.

For more advanced aortic blockages, treatments include:

• Open surgery: During open surgery, a surgeon will make an incision nearby or directly over the surgical site, which may be the abdomen, chest or both. Many open surgeries consist of the removal of the diseased part of the aorta and placement of a prosthetic graft (either a tube or a bifurcated/forked graft), depending on whether the surgeon must replace some of the branch arteries.
• Endovascular repair: A minimally invasive alternative to open surgery, endovascular repair does not require a large incision. A surgeon uses a catheter-based technique that allows them to fix the aorta from the inside out with the guidance of special X-ray technology. Endovascular repair involves the placement of an endograft in the damaged part of the aorta – an endograft is a type of stent (a tube made of a special metal wire covered with a fabric mesh) that support and cover the inner wall of the aorta. Endografts help restore healthy blood flow and prevent aneurysms from rupturing.

In addition to thrombolysis, surgery or endovascular intervention, aortic occlusive disease patients may need to take certain medications, such as a blood thinners or anti-inflammatory medicine, to manage the condition. Medication can be used on its own or combined with lifestyle changes such as eating healthier and quitting smoking.

Related Conditions

Paravisceral aorta, also known as coral reef aorta is a rare form of aortic occlusion disease where hard calcifications form on the inner wall of the aorta and protrude into the lumen (the open space of the artery). Coral reef aorta calcification can cause significant aortic stenosis (narrowing) that can lead to insufficient blood supply to the lower limbs and intestinal tract, as well as a narrowing of the arteries that supply blood to the kidneys (and associated high blood pressure). Coral reef aorta is typically treated via conventional surgical methods, including:

• Thromboendarterectomy: surgical removal of a blood clot to restore normal blood flow
• Thoracoabdominal bypass graft: a graft is connected to the aorta so that blood is directed around the blockage
• Covered stent graft replacement of the aorta

In addition to treating blockages of the aorta, the experts at University Hospitals Harrington Heart & Vascular Institute can repair blockages of the main arteries that branch off the aortic arch (the top, arch-shaped segment of the aorta) to bring blood to the head, neck, arms and other parts of the upper body. Often referred to as the great vessels, these branch arteries are the:

• Brachiocephalic artery (also called the trunk brachiocephalic trunk or innominate artery)
• Left common carotid artery
• Left subclavian artery

Similar to the treatment of other aortic occlusions, blockages of the great vessels may be treated with open surgery, endovascular stenting, medication and lifestyle modification.