Aortic Aneurysm Treatments
What is it?
An aneurysm is an abnormal bulge or enlargement in the wall of a blood vessel. Doctors categorize it depending on what part of the aorta the aneurysm appears in:
- Thoracic aortic aneurysm appears in the chest.
- Abdominal aortic aneurysm (AAA) occurs in the abdomen or belly area.
- Thoracoabdominal aortic aneurysm runs through the chest and abdomen.
The most common of these is the abdominal aortic aneurysm.
Not all aneurysms require immediate surgery. Depending on their size and other individual risk factors, a specialist may elect medical monitoring (often called “watchful waiting”). Medical monitoring includes regular visits with your doctor to make sure your aneurysm is not growing and managing other medical conditions that could make your aneurysm worse. If an aneurysm gets bigger, it increases your risk for an aortic dissection or ruptured aneurysm, which are immediately life-threatening conditions.
If your physician determines that the risk of a ruptured aneurysm or aortic dissection is greater than the risk of the surgery, they will typically recommend a surgical repair.
There are two main types of surgery for an aortic aneurysm – open or traditional surgery, and endovascular surgery using a stent graft. These procedures are known as endovascular or transcatheter repair.
Endovascular repair of an aortic aneurysm is a procedure that does not require a surgeon to open your chest or abdomen. During this minimally invasive surgery, an interventionalist uses a catheter (thin tube) to help place a stent graft (a mesh tube often made of stainless steel) into your aorta. Once the specialist places the catheter, they move it into the enlarged portion of your aorta (the aneurysm) and place the stent graft. The stent graft is a miniature device that redirects blood flow, avoiding the enlarged portion of the aorta (the aneurysm). The goal of the surgery is to keep the aneurysm from increasing in size.
Typically, the specialist enters the blood vessel through the groin via the femoral artery. If your femoral artery is too small in diameter to accommodate the catheter, this technique may not be an option, and you may require an open surgery. Additionally, thoracoabdominal aneurysms are only repaired surgically and cannot be repaired with endovascular methods.
Traditional or open surgery
If your femoral artery is too narrow or the location of the aneurysm makes endovascular repair too difficult or risky, surgeons may elect to use open surgery to repair the aneurysm. Your surgeon may need to make an incision in the chest or in the abdomen, depending on the location of the aneurysm. If the aneurysm is thoroacobdominal, both incisions will be required.
During open surgery to repair an aortic aneurysm, surgeons open the malformed portion of the aorta and insert a graft (a synthetic tube made of Dacron). Surgeons splice the tube and sew it to the healthy aorta. Blood flow now goes through the graft instead of the aneurysm.