Advanced treatment through multidisciplinary approach

From the Department of Surgery 2012 Annual Report

CDTA The Center for Diseases of the Thoracic Aorta offers advanced multidisciplinary treatment. Cardiothoracic and vascular surgeons work with primary care physicians to offer surgical or medical interventions and long-term surveillance.The Center for Diseases of the Thoracic Aorta was established in 2001 as a referral center for patients with acute and chronic aortic dissections, thoracic aortic aneurysms and Marfan syndrome. Its success stems not only from the advanced treatments offered at a major academic center, but from the collaboration of a multidisciplinary team of specialists — with each other and with the primary care physicians and cardiologists who refer patients.

“Diseases of the thoracic aorta are fairly rare, and it’s difficult for internists to keep up with the latest treatment options,” says Marc Moon, MD, Washington University cardiothoracic surgeon at Barnes-Jewish Hospital and surgical director of the center. “It’s not our goal to take over care of the entire patient, but we provide support and input into decisions of how to treat these uncommon diseases.”

Patients who are referred to the center generally already have been diagnosed with an aneurysm or a dissection — a potentially life-threatening condition in which there is bleeding into and along the wall of the aorta. Moon, the Joseph Bancroft Professor of Surgery; Luis Sanchez, MD, chief of the Division of Vascular Surgery and the Gregorio A. Sicard Distinguished Professor of Vascular Surgery, and all of the other vascular surgeons; and cardiologist Alan Braverman, MD, the Alumni Endowed Professor of Cardiovascular Disease in Medicine, all play an active role in evaluating patients.

Working with the patient’s primary care physician or cardiologist, the team may recommend surgical intervention, endovascular intervention or a medical approach with blood pressure control and long-term surveillance. Moon surgically treats aortic conditions in the ascending aorta, but works together with vascular surgeons on problems in the descending and thoracoabdominal aorta.

“Patients now present with more complex aneurysms than they did years ago, due in part to our ability to get them through an acute pathological state,” says Moon. “We can offer not only an open approach or endovascular approach, but a combined approach that brings together all the positives that both the thoracic and vascular surgeons can contribute.”

Yet Moon says medical prevention is the most important piece of the puzzle. Hypertension is the most common risk factor for the development of aneurysms and aortic dissections, with the patient’s primary care physician or cardiologist playing an intimate role in controlling this aspect of the disease.