July 27, 2017

Aortic Aneurysm

What is an abdominal aortic aneurysm?

The aorta, roughly as wide as a garden hose, is the largest artery in the body. The aorta supplies oxygen-rich blood to head as well as the rest of the body. This artery extends downwards through the chest and abdominal regions. An aneurysm is a bulging or weakness in the wall of the aorta. It is dangerous to have an abnormal bulge in the artery wall because the pressure could cause it to burst (rupture) putting the patient at risk of internal bleeding.

How do aneurysms form?

The weakening of arterial walls is usually caused by other medical problems like atherosclerosis (hardening of the artery), high blood pressure, or even physical trauma. Aneurysms also occur due to normal wear and tear from aging.

Tests used to diagnose severity of an aneurysm

Aneurysms are often discovered from routine check-ups for other medical issues. In order to identify the location of an aneurysm, different exams are used to see abnormalities in the aorta. These include:

  • X-Rays
  • 3-D CTA or MRA (computer-tomographic or magnetic resonance angiogram)
  • Echocardiogram
  • Angiogram

Life-style changes used to prevent or treat current aneurysms

Aneurysms can be closely linked to high blood pressure and atherosclerosis. Some preventative or treatable measures that a patient can take are:

  • Quitting smoking
  • Treating high blood pressure
  • Changing diets, controlling cholesterol
  • Exercising
  • Managing weight

What is done to repair or treat an aneurysm?

Waiting (small aneurysms)

This involves waiting and watching small aneurysms (smaller than 5cm, or less than 2 inches), to make sure that they don’t grow in size. Aneurysms will be monitored by doing ultrasounds/echocardiograms or CTAs on a periodic basis.

Surgery (large unruptured aneurysms)

  • Open Repair

Patients that are considered for open repair are those with aneurysms larger than 5cm, or bigger than 2 inches (in diameter?). Open repair involves complete removal of the aneurysm and replacing that section of aorta with Teflon tubing.

  • Minimally Invasive Repair, TEVAR

TEVAR stands for thoracic endovascular aortic repair. Using a small incision made in the groin, the surgical team uses a combination of X-Rays and catheters to maneuver the stent through the femoral artery. The femoral artery is found in the leg, in the groin area. Once the surgical team has pushed the catheter up the artery and confirmed that it is in the correct place, the stent is then “opened” up, much like a balloon. Minimally invasive surgery involves less surgical trauma as well as allowing for quicker recovery times. Patients who undergo TEVAR can be released from the hospital 1-2 days after surgery.

Advantages of TEVAR

  • no use of a median sternotomy
  • less blood loss
  • less postoperative pain
  • less risk of physical injury

Recovery time: 2-3 week

Aneurysm repair is very serious and can take 2-3 weeks even with a minimally invasive surgical approach.

Risks of surgery

  • Injury to the kidneys
  • Injury to blood flow to the spinal cord
  • Infection of the graft
  • Injury to the blood flow to the colon

Post-surgery risks:

  • Pain due to trauma of the surgical site
  • General infection

Goals of aneurysm repair

  • Prevent possible rupture
  • Lower the risk of internal bleeding