Aortic disease often progresses silently, with patients remaining asymptomatic until the condition reaches an advanced or life-threatening stage. Routine surveillance and timely imaging play a critical role in identifying disease progression and determining the right timing for intervention.

At the WashU Medicine and Barnes-Jewish Heart & Vascular Center, a team of advanced specialists emphasize careful monitoring and coordinated care to help guide treatment options to reduce the risk of life-threatening complications.

“Aortic disease can evolve for years without symptoms,” says WashU Medicine cardiothoracic surgeon Puja Kachroo, MD. “An aneurysm may enlarge slowly—without pain or noticeable signs—until the first presentation is a rupture or dissection.”

“It’s rare,” adds WashU Medicine vascular surgeon J. Westley Ohman, MD, “but when it becomes a problem, it can be lethal.”

American College of Cardiology and American Heart Association guidelines support earlier prophylactic repair in select patients with aortic disease—sometimes before the aorta reaches the traditional surgical threshold, particularly when genetic factors or family history increase risk.

With guideline recommendations moving toward earlier intervention for select patients, the focus shifts to careful monitoring and risk assessment over time. Specialized centers with dedicated aortic programs can provide ongoing imaging, genetic evaluation, and coordinated care among specialists needed to guide these decisions.

The WashU Medicine and Barnes-Jewish Heart & Vascular Center in St. Louis, brings together a collaborative, multidisciplinary team of WashU Medicine physicians at Barnes-Jewish Hospital dedicated to advanced endovascular and surgical care of complex aortic conditions. The Center integrates advanced chest imaging, ongoing surveillance, genetic testing, cardiology, cardiac surgery, and vascular surgery to manage the entire aortic disease spectrum within a single coordinated team, one of the only centers in the United States that offers this level of comprehensive expertise to care for patients with aortic conditions.

Expanding treatment options

“Sometimes,” Dr. Kachroo says, “the complexity of aortic disease only becomes apparent after complications occur. That’s why volume and experience across the entire spectrum of aortic disease matters.”

Patients at the Heart & Vascular Center, which treats the most complex and high-risk cases from across Missouri and the surrounding states, have access to both established surgical approaches and innovative therapies. These include groundbreaking clinical trials led by WashU Medicine physicians.

That breadth and volume of expertise expands treatment options, allows the team to determine the optimal timing for intervention, and tailors strategies to each patient’s anatomy and disease course.

WashU Medicine physicians manage a wide range of aortic pathology, including:

• 24/7 coverage for emergent conditions
• Aortic root and ascending aorta repair
• Complex aortic arch reconstruction
• Descending thoracic aortic aneurysm management
• Open thoracoabdominal aortic reconstruction
• Endovascular repair across multiple aortic segments
• Redo and revision aortic surgery
• Genetic aortopathy evaluation and surveillance
• Primary and secondary aortic infections

Among these capabilities, open thoracoabdominal repair remains a key differentiator.

“There are only a handful of centers nationally that perform open thoracoabdominal repair regularly,” Dr. Kachroo says. “It’s one of the most complex operations in aortic surgery, and it remains essential.”

Maintaining expertise in open surgery ensures patients are not limited to device-based options alone.

Continuity of care: One center, ongoing follow-up

A central advantage of comprehensive aortic care at the Heart & Vascular Center is continuity.

“Patients don’t have to move between multiple hospitals because one center doesn’t perform aortic replacement or another doesn’t manage descending aortic disease,” Dr. Kachroo says.

The program is structured to streamline access and minimize barriers to evaluation and treatment. Features include:

• Overlapping cardiac and vascular surgery clinics
• Same-day advanced imaging when appropriate
• Immediate cross-specialty consultation
• Multidisciplinary case review
• Telemedicine follow-up
• Coordination with the Barnes-Jewish regional network for local imaging with centralized oversight

“It becomes a one-stop model,” Dr. Ohman says. “Once a patient is referred, we assume responsibility for their care, including surveillance, timing of intervention, and post-operative care.”

Participation in national clinical trials

The center’s integrated structure also supports robust participation in national research.

“Many of these device trials are limited to select centers nationwide, including several open and endovascular aortic trials,” Dr. Kachroo says. “We participate in nearly all of them.”

The team has been among the earliest sites to enroll patients in several trials, providing access to investigational technologies.

“This reflects both our volume and our infrastructure,” Dr. Ohman says. “Patients here have access not only to current standard-of-care procedures but also to technologies that have the potential to define aortic treatment in the coming years.” 

Expertise in inherited aortic disease

Another distinguishing strength is the program’s large population of patients with inherited aortic disorders.

The Marfan Syndrome and Aortopathy Center, led by internationally recognized WashU Medicine cardiologist Alan Braverman, MD, follows hundreds of patients with connective tissue disorders.

“Genetic aortic disease is being identified more frequently,” Dr. Kachroo says. “These patients should be managed at experienced centers, as their care differs from degenerative aneurysm disease. Endovascular options are often limited in connective tissue disorders, making expertise in open surgery especially important.”

Indications for referral

For patients with aortic disease, a family history of unexplained death, or connective tissue disorders, early imaging and referral to a comprehensive, high-volume aortic center are low-risk, high-value steps that can help clarify the risk, guide ongoing surveillance, and determine timing for intervention while maintaining close collaboration with the patient’s care team.

“It’s never too early to refer,” Dr. Kachroo says. “Early referral will not hurt the patient. It preserves options and supports collaboration, allowing us to work closely with referring physicians to coordinate care and determine the best path forward together.”

Indications for referral include:  

• An aneurysm of any aortic segment 
  • Ascending
  • Arch
  • Thoracoabdominal
  • Abdominal
  • Aorto-iliac
• Aortic dissection
• Bicuspid aortic valve

Learn more about the advanced care and expertise in aortic disease at the WashU Medicine and Barnes-Jewish Heart & Vascular Center.