The Aortic Disease Program at the University of Utah Cardiovascular Center has an expert clinical team committed to providing innovative care for patients of all ages with aortic disease.
Our multidisciplinary team includes specialty-trained and board-certified cardiac surgeons, vascular surgeons, cardiologists, radiologists, anesthesiologists, and critical care specialists in addition to nurses, physical and occupational therapists, genetic counselors, and research coordinators.
Our comprehensive approach to aortic disease provides leading-edge medical and surgical care for patients throughout the Mountain West.
Treating Acute Aortic Syndrome
We provide 24/7 transfer services and emergency care for patients suffering from acute aortic syndrome. These include the following:
- Acute aortic dissection
- Aortic occlusion
- Penetrating aortic ulcers
- Aortic intramural hematoma
We also provide comprehensive evaluation and treatment for:
- aortic aneurysms,
- aortic valve disease,
- and genetic disorders affecting the aorta such as Marfan Syndrome.
Personalized Treatment For Aortic Disease
We know that some patients need personalized treatment options that meet their unique medical needs. We offer a range of treatment options for diseases affecting all areas of the aorta—from the aortic valve to the abdominal aorta. Our treatment options include:
- traditional open surgical repair options,
- minimally invasive surgical repair, and
- endovascular procedures.
Schedule a Consultation
To schedule a consultation with our experts, please call us at 801-585-6740.
Thoracic Aortic Aneurysm and Aortic Dissection
What is a thoracic aortic aneurysm?
The aorta is the largest blood vessel in the body. It delivers oxygenated blood from the heart to the rest of the body. An aortic aneurysm is a bulging, weakened area in the wall of the aorta. Over time, the blood vessel balloons and is at risk for bursting (rupture) or separating (dissection). This can cause life threatening bleeding and potentially death.
Once formed, an aneurysm will gradually increase in size and get progressively weaker. Treatment for a thoracic aneurysm may include surgical repair or removal of the aneurysm, or inserting a metal mesh coil (stent) to support the blood vessel and prevent rupture.
What causes a thoracic aortic aneurysm to form?
Different disease processes can cause thoracic aortic aneurysms including:
Degenerative disease that causes breakdown of the tissue of the aortic wall
Inflammation of the arteries (vasculitis)
What are the symptoms of a thoracic aortic aneurysm?
Thoracic aortic aneurysms may not cause symptoms. When symptoms do occur, they may be related to the location, size, and how fast the aneurysm is growing.
Sudden, severe pain associated with a thoracic aneurysm may be a sign of a life-threatening medical emergency.
Symptoms of a thoracic aneurysm may include:
Pain in the jaw, neck, or upper back
Pain in the chest or back
Wheezing, coughing, or shortness of breath as a result of pressure on the trachea (windpipe)
Hoarseness as a result of pressure on the vocal cords
Trouble swallowing due to pressure on the esophagus
The symptoms of a thoracic aortic aneurysm may look like other conditions. See your doctor for a diagnosis.
How is a thoracic aortic aneurysm diagnosed?
Your doctor will do a complete medical history and physical exam. Other possible tests include:
Computed tomography scan (also called a CT or CAT scan). This test uses X-rays and computer technology to make horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than standard X-rays.
Magnetic resonance imaging (MRI). This test uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
Echocardiogram (also called echo). This test evaluates the structure and function of the heart by using sound waves recorded on an electronic sensor that make a moving picture of the heart and heart valves, as well as the structures within the chest, such as the lungs and the area around the lungs and the chest organs.
Transesophageal echocardiogram (TEE). This test uses echocardiography to check for aneurysm, the condition of heart valves, or presence of a tear of the lining of the aorta. TEE is done by inserting a probe with a transducer on the end down the throat.
Chest X-ray. This test uses invisible electromagnetic energy beams to make images of internal tissues, bones, and organs onto film.
Arteriogram (angiogram). This is an X-ray image of the blood vessels that is used to assess conditions such as aneurysm, narrowing of the blood vessel, or blockages. A dye (contrast) will be injected through a thin, flexible tube placed in an artery. The dye makes the blood vessels visible on an X-ray.
What is the treatment for thoracic aortic aneurysm?
Treatment may include:
Monitoring with MRI or CT. These tests are done to check the size and rate of growth of the aneurysm.
Managing risk factors. Steps, such as quitting smoking, controlling blood sugar if you have diabetes, losing weight if overweight, and eating a healthy diet may help control the progression of the aneurysm.
Medicine. Used to control factors such as high cholesterol or high blood pressure.
Thoracic aortic aneurysm open repair. The type of surgery will depend on the location and type of aneurysm, and your overall health. For an ascending or aortic arch aneurysm, a large incision may be made through the breastbone. If an ascending aneurysm involves damage to the aortic valve of the heart, the valve may be repaired or replaced during the procedure. For a descending aneurysm, a large incision may extend from the back under the shoulder blade around the side of the rib cage to just under the breast. This lets the surgeon to see the aorta directly to repair the aneurysm.
Endovascular aneurysm repair (EVAR). EVAR requires only small incisions in the groin. Using X-ray guidance and specially-designed instruments, the surgeon can repair the aneurysm by inserting a metal mesh coil, called a stent-graft, inside the aorta. Not all thoracic aneurysms can be repaired by means of EVAR.
A small aneurysm or one that doesn't cause symptoms may not require surgical treatment until it reaches a certain size or is rapidly increasing in size over a short period of time. Your doctor may recommend "watchful waiting." This may include a CT scan or MRI scan every 6 months to closely monitor the aneurysm, and blood pressure medicine may be used to control high blood pressure.
Your doctor may recommend surgery if the aneurysm is causing symptoms or is large.
What is aortic dissection?
An aortic dissection starts with a tear in the inner layer of the aortic wall of the thoracic aorta. The aortic wall is made up of 3 layers of tissue. When a tear occurs in the innermost layer of the aortic wall, blood is then channeled into the wall of the aorta separating the layers of tissues. This generates a weakening in the aortic wall with a potential for rupture. Aortic dissection can be a life-threatening emergency. The most commonly reported symptom of an acute aortic dissection is severe, constant chest or upper back pain, sometimes described as "ripping" or "tearing." The pain may move from one place to another.
When a diagnosis of aortic dissection is confirmed, immediate surgery or stenting is usually done.
What causes aortic dissection?
The cause of aortic dissection is unclear. However, there are several risk factors associated with aortic dissection, such as:
High blood pressure
Connective tissue disorders, such as Marfan disease, Ehlers-Danlos syndrome, and Turner syndrome
Cystic medial disease (a degenerative disease of the aortic wall)
Aortitis (inflammation of the aorta)
Bicuspid aortic valve (only 2 flaps in the aortic valve, rather than the normal 3)
Coarctation of the aorta (narrowing of the aorta)
Excess fluid or volume in the circulation (hypervolemia)
Polycystic kidney disease (a genetic disorder characterized by the growth of numerous cysts filled with fluid in the kidneys)
Dr. Brooke grew up in Salt Lake City and received his Doctor of Medicine from the University of Utah before heading east to complete his internship and residency in General Surgery at the Johns Hopkins Hospital. During his Halsted residency, he received his Ph.D. in Clinical Investigation at the Johns Hopkins Bloomberg School of Public Health. He t... Read More
David Bull, MD, is a member of the Thoracic Oncology Program, a joint effort between Huntsman Cancer Institute and the University of Utah Hospitals and Clinics. The program was developed to offer consultation, diagnosis, and treatment for all chest cancers. Bull is a professor in the Department of Surgery, Division of Cardiothoracic Surgery; progra... Read More
Dr. Couldwell specializes in Neurosurgery, Brain Tumors, Brain Aneurysms, Skull Base Surgery, Stroke, Traumatic Brain Injury, Head Trauma and Neuro Critical Care.William T. Couldwell, MD, PhD serves as Professor and Chair of the Department of Neurosurgery at the University of Utah. He has served as Director of the American Board of Neurological Sur... Read More
Dr. Griffin grew up in England and moved to the United States in 1991. She received her Bachelor of Arts in Spanish from Florida State University and took time off during and after college to do volunteer work, teaching in both Spain and Honduras. She continued to pursue overseas outreach opportunities in medical school at the University of Flori... Read More
Larry W. Kraiss, M.D. is Professor and Chief of the Division of Vascular Surgery at the University of Utah. He is a graduate of Vanguard University of Southern California (BA: Science-Chemistry) and Baylor College of Medicine (M.D.). He took his general and vascular surgical training at the University of Washington in Seattle where he also spent th... Read More
Dr. McKellar is a native of Salt Lake City and received his Bachelor of Arts from the University of Utah and his Doctor of Medicine from the George Washington University School of Medicine. He completed his General Surgical and Cardiothoracic Surgical training at the Mayo Clinic in Rochester, Minnesota in a combined, integrated training program. ... Read More
Cardiothoracic Surgery, Cardiac Mechanical Support, Coronary Revascularization, Heart Failure, Heart Transplant, Lung Transplant, Minimally Invasive Heart Surgery, Minimally Invasive Lung & Esophageal Surgery, Valvular Heart Disease
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Dr. Mark Sarfati is board certified in General Surgery and Vascular Surgery. He serves as Associate Professor of Surgery (clinical) and as Adjunct Assistant Professor Radiology at the University of Utah. He is actively involved in several clinical research studies. Dr. Sarfati began his pursuit of medicine by attending Jefferson Medical College i... Read More
Dr. Schmidt specializes in the neurosurgical treatment of cranial disorders including brain tumors, meningiomas, aneurysms and vascular malformations, Chiari malformation, hydrocephalus, head trauma and critical care problems. Dr. Schmidt has been a cerebral vascular neurosurgeon at the University of Utah since 1993, providing comprehensive care o... Read More
Dr. Craig Selzman is a Professor of Surgery and Chief of the Division of Cardiothoracic Surgery at the University of Utah who specializes in the care of patients requiring heart surgery. He earned his undergraduate degree at Amherst College and medical degree at Baylor College of Medicine. He received his General and Cardiothoracic Surgery training... Read More
Cardiothoracic Surgery, Adult Congenital Heart Disease, Cardiac Mechanical Support, Coronary Revascularization, Heart Failure, Heart Stem Cell Therapy, Heart Transplant, Lung Transplant, Minimally Invasive Heart Surgery, Surgical Ventricular Restoration, Valvular Heart Disease
Dr. Brigitte Smith is a native of Wisconsin. She received her undergraduate degree at the University of Wisconsin, LaCrosse in Microbiology, Chemistry with a concentration in Biomedical Science. Her MD was awarded to her from the University of Wisconsin School of Medicine and Public Health. There she continued her residency in Vascular Surgery. ... Read More
Dee Jost, APRN, is a board certified family nurse practitioner. She has been a provider at the University of Utah Medical Center since 1994 and for Vascular Surgery since 1999. Prior to obtaining her advance practice degree, she worked within the UUMC Burn ICU and she maintains her interest in wound care as part of her current position. Other are... Read More
Joanna Lynch is a Physician Assistant with the Division of Vascular Surgery since joining the University of Utah in 2005. She provides care to hospitalized vascular surgery patients, assists in the operating room in open and endovascular surgeries and is a resource for dialysis centers. Since 2006 she has served as the Department of Surgery Physi... Read More
Heidi is a Nurse Practitioner specializing in Acute Care. She joined the University of Utah, Division of Vascular Surgery in 2014. Prior to being on staff here she worked at Intermountain Healthcare. She enjoys providing complete medical and surgical care of vascular patients.... Read More
Ariel is a Physician Assistant specializing in Vascular Surgery. She completed her Physician Assistant training in Dayton, Ohio. She moved from her home state of Kentucky to join the University of Utah, Division of Vascular Surgery in 2014. She enjoys the challenges of providing medical and surgical care of vascular patients.... Read More