Houston Heart
March 04, 2022

HCA Houston Healthcare is a leader in open surgical repair of thoracoabdominal aortic aneurysm (TAAA). This complex surgical procedure repairs aneurysms in the aorta that extend from the chest into the abdomen. Using state-of-the art interventions, HCA Houston Healthcare surgeons are able to restore aorta blood flow while reducing the risk of damage to various organ systems, paralysis, and death.

Open repair, when done by highly experienced teams, is a superior approach to repairing thoracoabdominal aneurysms. HCA Houston Healthcare's team is led by Hazim J. Safi, MD, who serves as the Medical Director of Aortic Surgery for HCA Houston Healthcare Medical Center and HCA Healthcare Gulf Coast Division. In this role, Dr. Safi is developing a national thoracoabdominal program and guiding quality and clinical outcomes.

Since his cardiothoracic residency at Baylor College of Medicine under Dr. Michael DeBakey, Dr. Safi has been on the front lines of the evolution of repair techniques for TAAA. He’s seen them evolve from the original “clamp and sew” approach to perfusion-assisted techniques with varying degrees of hypothermia. One of the most beneficial upgrades involves inserting a catheter at the beginning of the procedure to drain spinal fluid and relieve pressure created during surgery, reducing the risk of post-surgical paralysis. Dr. Safi's research shows that this has reduced the risk of paralysis from the waist down to overall three percent, but is less than two percent in the majority of TAAA patients.

However, Dr. Safi points out that while outcomes are much improved, it is still essential to be aware of patients' pre-operative health issues in order to avoid causing serious repercussions. For example, in a study in the Journal of Vascular Repair he demonstrated that poor pre-operative renal function is a statistically significant factor that dramatically influences mortality after open T AAA IV repair.

The procedure is surgically complicated and requires an experienced cardiovascular surgical team. “We have a great team of anesthesiologists, cardiologists, intensivists, surgeons and nurses here who do this procedure well. It’s not one person, it’s a team of experts who are taking on these cases,” says Dr. Safi. “It is a new era at HCA Houston Medical Center and we're now doing complex and sophisticated cardiovascular cases. We offer our patients the full spectrum of care.”

Here are answers to commonly answered questions regarding TAAA:

Who is at risk for developing a TAAA?

A TAAA can burst, which can cause life-threatening, uncontrolled bleeding, so understanding a patient’s risk factors plays a key role in preventing them. Patients with Marfan syndrome, an autosomal dominant condition resulting in connective tissue abnormality, often develop aortic aneurysms. Ehlers-Danlos syndrome, a collagen disorder, also causes TAAA. Other disorders associated with aortic aneurysms include Turner's syndrome, polycystic kidney disease, Loeys-Dietz syndrome, syphilis, arteritis (blood vessel inflammation), and traumatic

What are the signs of aortic aneurysm?

If you have a patient who is experiencing tenderness or pain in the chest, back pain, throbbing near the belly button, cough and/or shortness of breath, these are all signs that lead to the diagnosis of a thoracoabdominal aortic aneurysm.

The main risk of TAAA is rupture, which can lead to massive internal bleeding and death. Signs of a ruptured TAAA may include low blood pressure, increased heart rate, dizziness and/or sudden, severe pain in the abdomen, chest or lower back.