Aortic aneurysms: A silent killer and the surgeon fighting back

A passion for treating aneurysms

Whether in a midnight emergency aneurysm surgery or an 18-hour elective procedure, Dr. Orion brings passion and purpose to vascular surgery. Throughout her career, much of Dr. Orion’s research and expertise has focused on aneurysms.

High blood pressure, a family history or plaque buildup can damage and weaken blood vessel walls. If detected early, vascular surgeons can use preventive treatments to stop it from becoming worse, but many patients don’t know they have an aneurysm until it bursts. When that happens, the risk of death or serious complications is almost certain.

Helping patients overcome these seemingly impossible odds motivates Dr. Orion to power through hours-long surgeries.

“Cases that go well when I think we’re going to face more difficulty are what keep my light on,” Dr. Orion says.

Performing the art of vascular surgery

A significant part of a vascular surgeon’s life is performing emergency surgery. About one-third of the cases Dr. Orion treats occur in the middle of the night, making the hours long and the stakes high.

Vascular procedures take laser focus, creativity and the ability to pivot. Surgeries, which can be minimally invasive, open or a hybrid, are as much an art as a science. “One case presented to five vascular surgeons will have five different solutions, all of which can have a successful outcome,” says Dr. Orion.

“You have to have creative solutions because these are very complicated problems, and that’s one of the reasons patients choose Ohio State,” says Dr. Orion.

Building a center of excellence for aortic care

Dr. Orion directs The Ohio State University Wexner Medical Center’s Aortic Center, where a care team collaborates to simplify patient journeys. In one visit, patients can schedule an appointment with a vascular surgeon, a cardiologist and a cardiac surgeon, while also getting imaging.

This convenient care model results in better care. “In some tough surgeries, vascular and cardiac surgeons work side by side. There has to be tremendous collaboration, which we’re fortunate to have at Ohio State,” says Bryan Tillman, MD, PhD, a vascular surgeon and an associate professor of Surgery at The Ohio State University College of Medicine.

The volume of cases that come to the Aortic Center has increased, along with their complexity. “Simple aortic cases are hard to come by here. We usually get cases other hospitals deem too high-risk,” Dr. Tillman says.

Seeing the Aortic Center continue to grow under Dr. Orion’s leadership is no surprise to interventional cardiologist Ernest Mazzaferri Jr., MD, interim co-director of The Ohio State University Heart and Vascular Center, where he also serves as medical director of clinical operations. “All you have to do is prop the door open for her, and she comes blasting through to do more than I could ever imagine. She’s done that on multiple occasions,” he says.

Leadership in the operating room and beyond

The authority Dr. Orion commands in a room of surgical team members makes her a strong leader and mentor, says Alexandra Gobble, MD, chief vascular surgery resident.

“Dr. Orion can think quickly and make good decisions when people aren’t doing well, but she always maintains a calm presence so she’s in control,” Dr. Gobble says.

As the Aortic Center director, Dr. Orion is one of a small number of women leaders in vascular surgery in the United States.

She leads staff and medical students with confidence and kindness, whether she’s working with a surgical team or the whole vascular surgery inpatient unit. “Dr. Orion creates a culture of teamwork and collaboration around her because of the foundational leadership she displays,” Dr. Mazzaferri says.

Better screening improves aneurysm diagnosis

Diagnosis of aneurysms and cardiovascular disease, in general, has improved today through programs like mobile ultrasound machines in communities. “We're doing a much better job today screening and fixing them before rupture, but we still have a significant opportunity here,” Dr. Orion says.

In some patients, a computed tomography (CT) scan for an unrelated issue incidentally reveals an aneurysm. High-risk patients, such as men aged 65 or older with a smoking history or a family history of aneurysms, are proactively screened.

Once patients are identified as high-risk, vascular surgeons treat them over their lifespan. Unlike some surgical specialties that support patients briefly, vascular surgeons regularly monitor patients and help them make healthy lifestyle modifications — like diet, exercise and quitting smoking.

Pioneering aneurysm research to save more lives

Vascular surgery is advancing rapidly with new clinical trials and medical devices. “As new devices come to market, vendors want us to participate because they know we have the volume,” Dr. Orion says.

Of the clinical trials Dr. Orion oversees, most of her focus is on aneurysms. She's most excited about the stAAAble trial, which may slow the growth of, or even shrink, small and moderate-sized aneurysms. Although these are lower-risk, some patients are uncomfortable waiting for an aneurysm to grow before intervening, especially if they have had a friend or family member die from a ruptured aneurysm. “I think this is going to be a pivotal study in the next five to 10 years,” Dr. Orion says.

The trial aims to intervene by treating the aneurysm with a compound derived from mangoes that may strengthen the connective tissue inside the aortic wall — causing the aneurysm to shrink. “This might be a game-changer because we haven’t intervened on small to moderate-size aneurysms since we treated it with antibiotics, which didn’t work,” Dr. Orion says.

Another promising clinical trial she oversees is the AAA-SHAPE trial. Its goal is to cause sac regression. Operating surgeons hope it also will decrease the number of endoleaks after traditional endovascular aneurysm repair. In this trial, the surgeon places collagen plugs in the aneurysm sac to help the blood clot and the aneurysm shrink.

Mentoring the next generation of vascular surgeons

Fellows at Ohio State routinely graduate with over 100 open aorta cases during their training, while those in many other places may experience 10, says Dr. Tillman. “Our population is growing, and it’s expected that more patients will need aortic work done, so it’s important we’re training the next generation,” he says.

What makes Dr. Orion an inspiring teacher and mentor is her ability to share her passion and breadth of knowledge.

“Her biggest asset is that she’s an excellent teacher who gets everybody where they need to be to deal with difficult cases,” Dr. Tillman says.

Dr. Orion is known for talking through procedures as she works, which helps to include everyone in the room — from scrub techs to medical students. “She shares tips and tricks that are critical to helping patients recover well from these surgeries,” Dr. Tillman says.

As chief resident, Dr. Gobble strives to emulate Dr. Orion’s teaching and style, especially during difficult surgeries. “Besides her amazing surgical skills, I hope to model how she trusts us, commands respect in the operating room and cares so much about the patient. If I could be like any surgeon, it would be Dr. Orion.”