April 14, 2026
Under the best circumstances, aortic surgery aims to correct a problem before a life-threatening aneurysm or dissection occurs. The Mayo Clinic Aortic Center in Rochester, Minnesota, specializes in both preemptive aortic surgery and emergency aortic repair.
The ability to handle cases of all complexity levels is a hallmark of the Aortic Center. It reflects Mayo Clinic's long history of innovation and the development of teams and processes needed to support this work.
On the front line of innovation
Minimally invasive aortic repair, also known as endovascular repair, has been performed since the 1990s and has dramatically changed the treatment options for patients with aortic disease. Advances in this technology, including branched and fenestrated endovascular grafts, have enabled the treatment of highly complex disease in the entire aorta within both the chest and abdomen.
Mayo Clinic has been at the forefront of this innovation for more than 15 years with contributions to the field that have dramatically improved the safety, effectiveness and availability of these procedures. Innovations include the use of stents and other devices that are custom-made for each patient's specific anatomy.
With ongoing improvements in device technology and technique, endovascular innovation is now extending into portions of the aorta closest to the heart. Although the use of endografts in the ascending aorta and aortic arch is still early in its development, these areas introduce distinct anatomical and procedural challenges that require specialized expertise. "We participate in many clinical trials for these devices so we can offer patients more options," says Randall R. DeMartino, M.D., M.S., a vascular surgeon and chair of Vascular and Endovascular Surgery. "And as we approach the aortic root, we are working more closely than ever with our cardiac surgery colleagues to manage all aspects of care."
"There's an overall ethos of teamwork that ensures consideration of every treatment option."
A case study published in 2023 in the Journal of Vascular Surgery Cases, Innovations and Techniques demonstrates where these procedures are headed. The case involved an 83-year-old patient with an ascending aortic pseudoaneurysm. Due to age, prior surgeries and other health issues, the patient was not eligible for open surgery. Endovascular treatment involved placing two stent grafts into the ascending aorta. The patient went home two days later without complications.
Evaluating treatment options
Many patients with aortic disease have options for endovascular or open surgical repair. Deciding on the optimal treatment option involves considering multiple factors, thoughtful collaboration between vascular and cardiac surgical teams, and detailed discussion with the patient and family. It's particularly important that the patient and the patient's loved ones contribute to this discussion and have a clear understanding of the treatment options, expected outcomes and risks.
The decision for the optimal treatment strategy is often based on multiple factors, including:
- Anatomy. Sometimes, a patient has specific anatomy that is more suitable for an endovascular or an open procedure, and one type may provide greater safety and durability than the other.
- Previous procedures. Prior surgery can increase the risk of future procedures and strongly influence the safety and durability of either endovascular or open surgery.
- Social situation. Each patient has unique circumstances, and there are times when open surgery is warranted over an endovascular procedure due to the long-term follow-up required.
- Extent of aortic involvement. Issues affecting multiple sections of the aorta, particularly if the aortic valve is involved, may require open surgery or hybrid procedures that use both open and endovascular surgical techniques.
- Young age or genetic conditions. Young patients and those with genetic conditions that weaken the aorta may benefit from the durability of time-tested open surgical or hybrid procedures.
Collaboration and processes make the difference
The ability to successfully manage complex aortic diseases is, in part, a function of close coordination among specialists. At Mayo Clinic, care teams may involve vascular surgeons, cardiac surgeons, thoracic surgeons, vascular medicine specialists, cardiologists, radiologists, geneticists and rheumatologists.
"There's an overall ethos of teamwork that ensures consideration of every treatment option," says Andrew W. Hoel, M.D., the surgical co-director of the Aortic Center. This level of cooperation is critical when deciding the right surgical approach, timing of surgery and opportunities for medical optimization prior to surgery.
With its high volume, the Mayo Clinic Aortic Center in Rochester has cultivated experienced teams and established uniform treatment paradigms to optimize care. "We minimize unwanted variation wherever we can to enhance efficiency and prevent or manage complications," Dr. DeMartino says.
Mayo Clinic achieves care optimization with:
- Highly experienced and dedicated surgical teams in the operating room that have expertise in complex aortic care.
- Anesthesiology management by highly specialized cardiac anesthesiologists who have specific training and technical expertise in caring for patients undergoing aortic procedures.
- ICU staffing 24/7 by an in-house critical care physician and team with experience managing the complex postoperative care of patients who had aortic surgery.
- Patient recovery on a dedicated vascular unit in the hospital.
- Personalized postoperative care tailored to each patient's needs.
- Support for patients who travel to Mayo Clinic for care and close communication with their local healthcare professionals before and after surgery to ensure long-term continuity.
This methodical approach is essential in all aortic care but is particularly impactful in the emergency care of ruptured aortic aneurysms, acute aortic dissections and other acute aortic syndromes. Patient assessment, team coordination and real-time multidisciplinary communication are all streamlined so patients can be treated quickly.
"Whether a situation is noncritical or emergent, straightforward or complex, this mindset helps us deliver effective and lifesaving care," Dr. Hoel says.
For more information
Lima GB, et al. Endovascular repair of an ascending aortic pseudoaneurysm. Journal of Vascular Surgery Cases, Innovations and Techniques. 2023;9:101279.
Mayo Clinic Aortic Center.
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