Background for Non Clinicians
The aorta is the main conduit for blood from the heart to all organs and limbs of the body. The start of the vessel is the aortic annulus of the heart aortic valve.
Key branches include: coronary arteries, head and neck vessels (brachiocephalic, left common carotid and left sub-clavian arteries) and visceral vessels (coeliac, superior mesenteric and renal arteries) before bifurcating into the iliac arteries to the legs.
A number of acute and chronic disease processes afflict the aorto-vascular tree, typically however the problem is aneurysmal expansion of segments which if left untreated present as acute dissection or rupture. Intervention is typically either replacement or endovascular stenting of various segments either:
- Root, ascending, arch and/or descending aorta stent
- Thoracoabdominal sections
In many countries there exists the specialty of cardiovascular surgery with associated training programmes. Within the UK, there exist specialties of cardiothoracic surgery, vascular surgery and interventional radiology.
As such cardiac surgeons have traditionally managed the thoracic aorta and vascular surgeons the abdominal aorta, with interventional radiologist contributing endovascular intervention. This model of care can be disjointed and not necessarily to the benefit of patients.
Currently management of the aorta in the Merseyside and Cheshire STP, North Wales and The Isle of Man is shared between Cardiac Surgeons at Liverpool Heart and Chest Hospital and Vascular Surgeons at Royal Liverpool University Hospital, Aintree University Hospital, Southport Hospital and Ormskirk and St Helens and Knowsley Trust, as part of LiVES - included in LiVES are Interventional Radiologists.
Over the last two decades an ad hoc arrangement has evolved between Cardiac Surgery and LiVES with accepted and amicable cross site working for selected patients. Collaborative working is mostly through discussion and agreement of patient specific management plans for their aortic pathology at the monthly Aortic MDT.
Intervention on the proximal segments of the thoracic aorta and infra-renal aorta have in the main been managed without Aortic MDT discussion or cross site working with aortic root and most aortic arch work managed at LHCH and infra-renal aortic work managed by LiVES at RLUH. The added value of the Aortic MDT is mostly but not entirely, in the bespoke management algorthms for managing the thoracoabdominal aorta.
Patients with borderline disease and borderline health status are discussed at this meeting and allocated to either surgery, endovascular stent, further follow-up or medical management. Intervention occurs at both sites depending on the disease, form of intervention and expertise. It goes without saying that each centre performs a significantly higher volume of work on coronary, valvular and peripheral arterial/venous disease.
With this model of care, over the last two decades Liverpool has become renowned worldwide for aortic care, and in particular the thoracoabdominal intervention we provide for the patients in our region and beyond. The level of collaboration between cardiac surgery and vascular surgery in Liverpool is higher than in most UK centres, and this has served our patients well, however far short of international centres of aortic excellence in which there is a recognised specialty of cardiovascular surgery allowing for completely integrated and better cradle to grave bespoke patient care.
We believe that by combining selected services the Thoracic Aortic Service and LiVES will be more than the sum of its parts, to the benefit of our patients.