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Back to Cardiovascular Diseases
Aortic
aneurysm
Updated: September 19, 2006
Treatment
When detected in time, most ruptures can be prevented by repairing the
aneurysms with an operation. Treatment for an aneurysm depends on its
size and location and the general health of the person. If the aneurysm
is small and without symptoms, a "watch-and-wait" approach may be
suggested with regularly scheduled images of the aneurysm to check the
size. However, if the aneurysm is large enough, or if the aneurysm is
growing more than 1 centimeter per year, surgery may be the best option.
Women are more likely than men to die from aortic dissection according
to one of the first studies of its kind reported. Aortic dissections may
involve the ascending aorta alone, the descending thoracic and abdominal
aorta alone, or the entire aorta. The risk of death depends on the
extent of the dissection. It is highest for those aneurysms involving
the ascending aorta. For that reason, most of these aneurysms are
treated surgically as an emergency. Dissections of the descending
thoracic aorta can often be treated with blood pressure control. The
medical treatment of aortic dissection includes aggressive control of
blood pressure and heart rate while the aorta heals. The risk of death
with medical treatment of descending thoracic aortic dissection is about
10 percent. If surgery is required, however, the risk is higher at about
30 percent. Every effort is therefore made to treat these patients with
medication.
Surgery is usually required to repair an AAA, but modern, catheter-based
technologies using endovascular grafts have made treatment less invasive
in many cases. The combination of early diagnosis and modern treatment
of aortic aneurysms can save countless lives lost due to aneurysm
rupture each year.
Surgical treatment of AAA
Surgical treatment of AAA has been performed for almost 50 years and is
a successful and durable procedure. In surgery the diseased part of the
aorta is replaced with a Dacron or Teflon graft that is carefully
matched to the normal aorta and is sewn in place by the surgeon. While
ultimately curative, this operation requires a major abdominal incision
and general anesthesia, and the hospital stay averages 7-10 days for
most patients. Even after uncomplicated surgery, it is often a month or
two before patients can return to a full and normal life. Nevertheless,
more than 90% of patients make a full recovery from surgery. After more
than half a century of experience with these procedures we know that
once patients have recovered, their aneurysms are permanently cured.
Less Invasive Treatments of AAA
Recent advances in catheter-based technologies have led to exciting new
treatments for aortic aneurysms. Now, endovascular grafting technology
allows surgeons to repair the AAA by delivering a graft through a small
incision in the groin, rather than the traditional major open surgery.
The endovascular method, approved by the FDA in 1999, allows the graft
to be delivered via a catheter (tube) inserted in a groin artery. In the
operating room, x-ray guidance is used for proper positioning of the
graft. The graft is then expanded inside the aorta and held in place
with metallic hooks rather than sutures. The hospital stay is usually
only one or two days, and most patients can return to work or normal
daily activities in about a week. Even patients with serious medical
problems, once thought to be too sick, or too frail to have surgery for
AAA, may have their aneurysm repaired using an endovascular graft. This
can avoid the need for major open surgery and also eliminate the risk of
fatal rupture if the AAA was not treated at all. It’s very important for
patients to know that endovascular grafting may not be possible in every
case. Endovascular grafts are specially manufactured and don’t “fit” for
every case. Also, in many cases, standard surgery is still the best
since we don’t have 50 years of experience with these newer procedures
like we do with surgery. There may still be serious problems we haven’t
anticipated.
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Follow up
Once the acute dissection has healed, adequate control of blood pressure
may eliminate the need for surgery. Lifelong monitoring of diameter of
the aorta is required because a previously dissected descending thoracic
aorta may enlarge and rupture.
Prognosis and survival
Because the abdominal aorta is such a large blood vessel, a ruptured
abdominal aneurysm is a life-threatening event. Fortunately, not all
aneurysms rupture. Many grow very slowly and cause no symptoms or
problems for many years. However, all have the potential to rupture and
thus must be identified and treated or watched very carefully. The
combination of earlier diagnosis with safer, simpler, and ever more
successful treatments can prevent needless deaths due to ruptured
abdominal aortic aneurysms. Timely suspicion and consultation with the
family doctor and a simple ultrasound test can tell whether a person has
aneurysm.
The length of the operation and the risks involved depends on the extent
of the repair required, and on the patient's general health. Recovery
time varies. Most people need at least a month or six weeks to recover
from aneurysm surgery. The length of the hospital stay depends on the
patient's condition and the operation performed, but it is typically a
week.
Although endovascular surgery reduces recovery time to a few days, it
still carries risk. And because the procedure is fairly new, long-term
results are unknown. Complications can occur with this procedure, namely
blood leaking from the graft, known as endoleak. For this reason,
patients who have repair of their aortic aneurysms with stent-grafts are
initially required to return for monitoring every six months.
Recent news and research
Cocaine users in their mid-40s are found to have more than four times
the risk of coronary artery aneurysms as non-users as per the Journal of
the American Heart Association. It is believed that cocaine predisposes
to coronary artery aneurysms, and then the aneurysms themselves may
predispose to heart attacks.
The Food and Drug Administration has approved a new device called GORE
TAG Endoprosthesis System that is intended to prevent ruptures of
descending thoracic aneurysms by making a new path for blood flow. It is
the first endovascular grafting system approved to treat aneurysms of
the thoracic aorta.
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