Preventing aortic aneurysms

The major societies’ guidelines are fairly nebulous about how best to manage patients with mildly or moderately dilated aortas, Dr. McGarvey says. Such guidelines recommend that patients with dilation of the aorta receive imaging of the aorta every 6 to 24 months—a recommendation that clinicians apply differently from patient to patient. “This creates a lot of confusion for primary care physicians, cardiologists, and ER doctors in terms of what to do with people who have dilated aortas,” adds Dr. McGarvey.

To bring clarity, Dr. McGarvey has developed a program to define an institutional standard of care for aortic aneurysm management. The model considers risk factors including aorta size, body size, family history, and genetics to determine the frequency of surveillance and when to recommend surgical consultation.

“This approach removes some of the confusion and also allows us the plasticity to alter the algorithms and treatment pathways if the guidelines change based on new information,” he says.

Acute repair of aortic tears

When patients experience an acute aortic event, time is of the essence. “Often these patients are transported directly to our operating room, and we’re trying to address the pathology as quickly as possible,” Dr. McGarvey says. “With a center dedicated to aortic care, we have a bunch of tools in our toolbox to deal with the range of acute pathologies.”

Aortic disease often involves the aortic root and valve, and for decades, surgeons have addressed aortic dissection and rupture by replacing the damaged section of the vessel. While this remains the focus of standard-of-care approaches, treatments have evolved in recent years to be more aggressive about preserving the aortic valve. This can improve long-term outcomes, especially in younger patients.

Dr. McGarvey notes that modern surgical approaches also emphasize correcting the aortic arch, a benefit to patients who may need additional future surgeries to address residual dissection in the descending aorta. “With a little bit of foresight, we can do a repair that sets ourselves up for success down the road,” he explains.

Aortic aneurysm management: Preventing aortic dissection

Penn Medicine has an experienced team of specialists who care for aortic aneurysms in both acute and chronic surveillance settings. “The aorta is connected to everything,” Dr. McGarvey observes. This means that managing aortic aneurysms is best done with a multidisciplinary approach.

In addition to specialized cardiac providers, the team collaborates closely with colleagues in vascular surgery and radiology, as treatment approaches have advanced to include more endovascular procedures with complex imaging techniques.

The aorta team at Penn Medicine Lancaster General Hospital welcomes patients into their surveillance program and is also available for consultation when surveillance identifies that an aneurysm has grown. “Ultimately, the decision to proceed with surgery is based on a risk-benefit analysis, where we balance the risk of elective aortic surgery with the risk of ongoing medical management and image surveillance,” says Dr. McGarvey.

Because that surveillance program is designed to evolve with new technologies and surgical standards, patients will always receive the most up-to-date care, he adds. As chronic management of aortic pathology advances, Dr. McGarvey is hopeful that acute aortic procedures will become less common. “But we’re always prepared when the acute aortic pathology walks in the door,” he adds.

Clinical consult and patient referral

Dr. Jeremy R. McGarvey sees patients at Penn Medicine Lancaster General Health in Lancaster, PA. For a provider-to-provider consultation, call 877-937-7366, or refer a patient online.