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Aortic Aneurysm Repair

The body's main artery, known as the aorta, carries oxygen-rich blood away from the heart to be pumped throughout the body – to the brain, muscles, organs, legs and other cells. The aorta extends out of the top of the heart (the left ventricle) and descends down through the chest cavity and into the abdomen. If issues occur within this artery, the blood supply of the entire body may be at risk.

One such issue that may compromise the function of the aorta is the development of an aortic aneurysm. When this occurs, the wall of the aorta expands in a particular location and develops an abnormal bulge due to weakening of the wall. Aneurysms can occur anywhere along the aorta but are characterized by the two main areas where the aorta runs through – the chest (thoracic aortic aneurysm) and the abdomen (abdominal aortic aneurysm).

Aortic aneurysms typically grow slowly but they carry a very big risk – they can result in the aorta dissecting or rupturing. These are very serious conditions in which the aorta tears and they can be fatal. Fortunately, many aneurysms don’t cause problems for many years. If detected in time, they can be repaired via surgery so they do not dissect or rupture. The decision on how to treat aortic aneurysms will depend on a number of factors, including the size of the aneurysm, where it is located, how fast it is growing, and the patient’s overall health.

TYPES OF AORTIC ANEURYSMS

Differentiating between types of aortic aneurysms is done primarily by their location. These include:

  • Thoracic Aortic Aneurysm – Occurs in the section of the aorta that passes through the chest cavity. Aortic aneurysms in the chest are most commonly caused by sudden injury or high blood pressure, but can also be due to an inherited connective tissue disease. The symptoms of a thoracic aortic aneurysm include shortness of breath, sharp and sudden pain in the chest or upper back, and trouble breathing or swallowing.
  • Abdominal Aortic Aneurysm – Occurs in the section of the aorta that passes through the abdominal cavity. These are the more common type of aortic aneurysm. Abdominal aortic aneurysms are typically caused by atherosclerosis, but can also occur due to injury or infection. Symptoms often do not occur with an abdominal aortic aneurysm, but they may be accompanied by pain in the groin, buttocks, or legs and throbbing or pain in the back or side of the body. Symptoms include:
    • sudden, sharp pain the the chest, belly (abdomen), lower back, flank (over the kidneys)
    • a pulsating feeling in the belly
    • low blood pressure and fast pulse

People who are at an increased risk for an aortic aneurysm include those with high blood pressure, hardened arteries (atherosclerosis), high cholesterol, smokers, or a family history of aortic aneurysms. Severe physical or emotional stress increases blood pressure.

Risks of Aortic Aneurysms

The primary risk associated with the existence of an aortic aneurysm is that the bulge (weakened area of the aorta) will either dissect or rupture.

  • Aortic Dissection – This refers to the development of a tear in the inner wall of the aorta. The aorta is weakened due to this separation and blood can leak between the layers or it can block the flow of blood through the aorta to the rest of the body. Aortic dissection can also lead to rupture, a life-threatening emergency. Symptoms of aortic dissection are often similar to a heart attack.
  • Aortic Rupture – When an aortic aneurysm bursts, it is known as a rupture. This causes blood to leak out of the aorta into the rest of the body. It is an extremely dangerous condition that is often fatal.

Aortic Aneurysm Repair

After diagnosis of an aortic aneurysm, a doctor may recommend the patient undergoes aortic aneurysm repair surgery to prevent an aortic dissection or rupture from occurring.

Aortic aneurysm repair can be performed in two ways:

  • Open Repair – This procedure involves a large incision made in the chest or abdomen to expose the weakened area of the aorta. Once the aorta is accessible, a graft is used to mend the aneurysm and make the compromised area of the aorta stronger. This procedure is the standard for aortic aneurysm repair.
  • Endovascular Aneurysm Repair (EVAR) This is a minimal access procedure used for aortic aneurysm repair. The doctor makes a small incision in the groin and inserts a catheter in an artery that leads up to the location of the aneurysm. At the site of the aneurysm, the doctor uses the catheter to place a graft or stent to prevent further damage.

Treatment Risks

Treatment risks vary depending upon how aortic aneurysm repair surgery is performed.

Open repair risks may include:

  • bleeding during or after surgery
  • irregular heart rhythms
  • heart attack
  • loss of blood flow to legs from a blood clot
  • infection of the graft

EVAR risks may include:

  • bleeding
  • damage to surrounding blood vessels or organs
  • loss of blood flow to legs from a blood clot
  • leaking of blood from graft into aneurysm sac (endoleak)
  • groin wound infection

What to Expect After Surgery

After aortic aneurysm surgery, patients are usually sent to the intensive care unit (ICU) at first. In the ICU, the patient's blood pressure, heart activity, breathing rate, and oxygen level are closely monitored. Once the medical staff feels the patient is ready to be moved, he or she will be transferred to a general hospital room to continue recovery. Activity will be gradually increased and patients will be encouraged to get out of bed and walk around when possible.

After patients are sent home, patients are encouraged to continue to become more active again, starting with short distance walks. While aortic aneurysm repair will take care of the immediate problem of the aneurysm, it does not cure any underlying blood vessel issue. To prevent additional cardiac complications, doctors often recommend that patients adopt healthier lifestyle changes such as eating healthier, getting regular exercise, and stopping smoking.

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