Collaboration and innovation equals a multidisciplinary dream team for complex aortic disease
The aorta and its major arteries carry blood to all the body’s essential organs. Because of this, an aortic aneurysm or dissection can be quite serious. Should surgical treatment be needed to avoid a life-threatening rupture or other adverse event, there are a wide variety of possible approaches available, each with a combination of benefits and drawbacks.
Treatment for complex aortic disease is rapidly evolving, with a broad range of open and endovascular options supported by leading-edge technology. At Inova, our complex aortic disease team collaborates to provide that full scope of treatment options, working shoulder to shoulder in Inova Schar Heart and Vascular’s hybrid ORs to design and execute customized treatments for each patient.
Our complex aortic disease team includes vascular surgeon Kendal Endicott, MD, Director, Inova Complex Aortic Vascular Program; cardiac surgeon Liam Ryan, MD, Medical Director, Inova Aortic Center; and interventional radiologist David Spinosa, MD. These three physicians work side by side, providing complementary perspectives on complex aortic aneurysmal disease and dissections.
How our collaborative approach benefits patients
Each aortic disease case is unique due to individual anatomic variations and differences in disease process and comorbidities. To address these differences optimally, each team member has skills and strengths that the team deploys in specific situations.
For example, in the ascending aorta and across the aortic arch, Dr. Ryan’s expertise in open approaches is essential for more technically intricate repairs that position the patient for the best long-term outcomes, particularly if more surgery is needed down the line, which is often the case with aortic pathologies. Our team’s open aortic repair mortality rate is less than 1%, far better than the national average of about 7%.
Prior to these open elective repairs, the entire team provides essential input into the strategy that provides the best short- and long-term outcomes. “In our program, patients are getting input from at least two, if not three, surgeons,” Dr. Ryan said. “We owe it to our patients to consider all options and perform the repair in the best way possible for them.”
In the descending thoracic aorta, Dr. Endicott’s and Dr. Ryan’s expertise overlap, giving the team a wide variety of both open and endovascular approaches to offer. This provides a particular benefit to patients who are not candidates for open procedures because of prior open surgery or who have a higher risk profile.
“In patients who have had two sternotomies and can’t have a third, we’re able to treat the aorta endovascularly from the ascending aorta all the way down to the iliac arteries with outstanding outcomes,” Dr. Endicott said. “Patients who find themselves out of open surgical options may still have alternatives to treat their aortic disease.”
Dr. Spinosa’s interventional radiology experience enables the team to safeguard patients by responding to complexities that emerge and pivoting intraoperatively, thanks to high-definition, real-time imaging capabilities such as intraoperative CT, which the team calls “a tremendous advantage.” He also wields microcatheters and other specialized tools to reach and repair small, delicate areas or connect grafts, particularly in the various branches from the aorta.
The team performs these procedures in a hybrid cardiovascular OR equipped for both endovascular and open procedures and supported by highly advanced imaging technology. “It’s a dance when we’re all in there,” Dr. Endicott noted. “We have different roles, and we each have our own unique strengths.”
Innovation at every stage
During the pre-procedure evaluation, the team reviews the patient’s imaging studies and talks through options to decide upon the recommended operative strategy. To support these discussions, Dr. Spinosa uses Inova’s 3D laboratory to create a model of the patient’s aorta. This technology, in addition to advanced aortic software, helps the team decide the best operative approach.
As graft options expand, our ability to offer more complex endovascular options does, too. Inova is also in the final stages of approval for the GORE® ARISE II Trial – an ascending stent graft to treat ascending aortic pathology as a less invasive option to open surgical repair. “We can now stent almost any anatomy,” Dr. Ryan said. “Putting our expertise all together, there is very little we can’t handle.”
After the procedure, the team conducts robust follow-up and long-term quality and outcomes monitoring. “We follow the patients and their imaging together, which helps us understand how our grafts are performing over time,” Dr. Spinosa said.
Close collaboration, enabling innovative teamwork in the OR, has translated into exceptional outcomes for Inova’s complex aortic disease team. “The days of a patient with a problem seeing one doctor and having one option is not what medicine should be any longer,” Dr. Spinosa said. “Patients should see a team of experts, who should discuss multiple options and present them to the patient, so the patient can be treated in a way that is best and safest for them. That is the biggest advantage of the multidisciplinary approach we use here.”
Learn more about our complex aortic program.