Aneurysm Repair
An aneurysm refers to a bulge or ballooning in the wall of an artery due to a weakened segment of an artery wall. The exact causes of aneurysms are sometimes unknown, although some individuals have a familial tendency to get them. Aortic disease or an injury may also lead to the formation of an aneurysm.
Risk factors for aneurysms include a family history of the condition, high blood pressure and tobacco use. Aneurysms can potentially occur in any artery, but the most common types are:
- Aortic aneurysm: Affects the primary artery carrying blood from the heart to the body.
- Thoracic aortic aneurysm (TAA): Occurs in a section of the aorta within the chest (thorax).
- Abdominal aortic aneurysm (AAA): Occurs in a section of the aorta in the abdomen.
- Popliteal artery aneurysm: Found in the artery behind the knee.
- Mesenteric artery aneurysm: Occurs in an artery supplying blood to the intestine.
- Splenic artery aneurysm: Affects an artery associated with the spleen.
- Renal artery aneurysm: Affects an artery that travels to the kidney.
- Pelvic aneurysm: Affects the vessel going to the groin from the abdomen.
Aneurysms can develop slowly over many years and often have no symptoms. When an aneurysm rapidly expands or ruptures, the resulting symptoms can vary depending on its location and may develop suddenly. Symptoms of an aortic aneurysm may include:
- Difficult or painful swallowing: If the thoracic aneurysm pushes on the esophagus.
- Difficulty breathing: If the thoracic aneurysm pushes on the trachea or windpipe.
- Feeling full: Being full quickly after consuming only a small amount of food.
- Hoarseness: If the thoracic aneurysm pushes on the nerves in the chest.
- A pulsating or throbbing feeling in the stomach area.
- Leg swelling: If the aneurysm in the groin or behind the knee pushes on the veins.
Aneurysms may develop and reach a significant size before exhibiting any symptoms. When an aneurysm becomes large, it has the potential to rupture, leading to dangerous bleeding or even death. Fortunately, doctors can often prevent aneurysm rupture with early detection and treatment. Other complications may include the aneurysm clotting and stopping blood flow to an extremity.
Doctors use various diagnostic techniques, including angiograms, magnetic resonance imaging (MRIs), computed tomography (CT) scans or ultrasound tests. Interestingly, aneurysms are often discovered by chance during tests conducted for unrelated conditions. The primary treatments for aneurysms involve medications and surgical/endovascular interventions.
Various surgical procedures address different types of aneurysms. Doctors perform aneurysm surgery to repair or replace the defective section of the aorta. The treatment approach for aortic aneurysm depends on its size, location and risk factors. Small aortic aneurysms can be managed with healthy lifestyle modifications such as smoking cessation and blood pressure control to slow down its growth and reduce the risk of rupture or dissection. Doctors may address other medical conditions that increase a person’s risk, such as high blood pressure, coronary heart disease, chronic kidney disease and elevated blood cholesterol levels. In most cases, routine imaging is performed to monitor the aneurysm site. Surgical intervention may be recommended to repair large aneurysms once the risk of rupture exceeds the risk of repair.
Abdominal aortic aneurysm surgery is typically recommended when the aneurysm reaches a maximum diameter of 5.5 centimeters (approximately 5 centimeters in women). For larger aneurysms, the risk of rupture outweighs the risk of surgery. Surgery is also considered if a person has a family history of ruptured aneurysms. However, surgery may pose additional risks for people with poor health or who have underlying medical conditions. The decision for surgery is an individualized one that is made after discussions with the vascular surgeon and the patient.
A thoracic aortic aneurysm occurs in the chest. These aneurysms are closely monitored when small, and surgical intervention is typically considered when they reach 6 centimeters in size. Treatment with stents has improved the outcomes for thoracic aneurysms. In cases affecting a large portion of the aorta, surgery and stenting may be recommended.
Studies indicate that for individuals with aneurysms measuring less than 5.0 centimeters (approximately 2 inches), it is safer to avoid surgery. The risks associated with the operation outweigh the potential benefits.
There are two main options:
- Open surgical repair: The less frequently performed type of surgery for aneurysms. In open surgical repair, the patient is given anesthesia. The vascular surgeon will then begin the operation by making an incision in either the abdominal area or chest, depending on the aneurysm location. Then, the aneurysm is replaced with a graft (usually a leak-proof polyester tube) sewn in its place.
- Endovascular aneurysm repair (EVAR): EVAR is a minimally invasive procedure performed through a groin approach. The advantages over open surgical repair include smaller incision size and shorter recovery time. EVAR is more commonly used for abdominal aortic aneurysms than thoracic aortic aneurysms. A small incision is made during the procedure, typically in the groin area. A stent graft, (a stent covered with fabric), is then guided through the patient’s blood vessels to reach the aorta. The stent graft expands and securely attaches to the aortic walls, creating a seal that prevents blood from entering the aortic aneurysm. The main drawback of EVAR is the need for continued lifetime monitoring.
If you have had aneurysm repair surgery, your doctor might recommend regular imaging tests, such as CT scans or ultrasounds, to monitor repairs post-surgery. Additionally, your doctor may offer the following recommendations to help you prevent complications due to an aneurysm:
- Take prescribed medications. Follow your doctor’s medications to manage conditions like high blood cholesterol and blood pressure. Take antibiotics, if prescribed, to prevent infection around the stent graft before dental procedures or other invasive medical interventions.
- Incorporate healthy lifestyle modifications, such as:
- Avoid very heavy lifting: Refrain from lifting heavy weights or objects to prevent unnecessary strain on your blood vessels.
- Stress management: Minimize stress, as it can impact blood pressure.
- Quit smoking: Adopt a heart-healthy lifestyle by quitting smoking. You can call the National Cancer Institute’s Smoking Quitline for free assistance at 1-877-44U-QUIT (1-877-448-7848).
- Screen for other aneurysms. Consider screening for aneurysms in other areas, such as your pelvis or legs. Regular monitoring helps detect any potential issues early.
If you experience any symptoms related to a rupture or tear in the aorta, such as light-headedness, rapid heart rate and sudden, severe pain in your stomach area, chest or back, go to the nearest emergency room or dial 911.
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