An aortic aneurysm is a protrusion or ballooning in the wall of the aorta, the major artery that transports blood to the rest of the body from the heart. When this vital conduit weakens and enlarges, life-threatening complications can occur.
When an aortic aneurysm reaches a certain magnitude or poses a significant risk of rupture, you will need a surgical intervention. It is the only method to prevent rupture and repair an aortic aneurysm. Understanding the different types of surgical interventions for aortic aneurysms can help you make informed decisions about your care.
What is an Aortic Aneurysm?
Aortic aneurysms are unusual bulges that develop in the aortic wall. These can develop anywhere along the aorta, although they are most prevalent in the abdomen and chest.
The most prevalent cause of aortic aneurysms is atherosclerosis, characterized by plaque buildup on the arterial walls. Plaque can harm the aortic wall, rendering it weakened and more likely to bulge.
Smoking and hypertension are two of the most significant risk factors for aortic aneurysms. Hypertension places an additional burden on the aortic wall, whereas smoking damages the aortic wall. Certain medical conditions, such as Marfan syndrome and Ehlers-Danlos syndrome, can also increase your risk of developing an aortic aneurysm.
Recognizing the Signs
Aortic aneurysms are frequently asymptomatic, making them particularly difficult to detect. Depending on the location of the bulge, some individuals may experience sudden and severe discomfort, abdominal pulsing, hoarseness or difficulty swallowing, and respiratory difficulties.
High blood pressure, or hypertension, can increase the risk of developing and advancing aortic aneurysms. The aortic wall can be compromised over time, making it more susceptible to aneurysm formation.
It is crucial to monitor blood pressure to detect and treat hypertension regularly. Collaborating with healthcare providers can help control blood pressure and lower the risk of aortic aneurysms.
Diagnosing Aortic Aneurysms
CT scans, MRIs, and ultrasounds typically diagnose aortic aneurysms. These are all imaging tests that a healthcare professional can use to diagnose aortic aneurysms. Aneurysm diagnostic instruments generate detailed images of the body’s interior, including the aneurysm’s size and location.
MRI scans provide the most detailed images of the aorta among three diagnostic methods. However, they are also the most expensive and time-consuming. Healthcare professionals use MRI scans to diagnose aortic aneurysms in patients allergic to contrast dye or with kidney disease.
For further diagnosis, healthcare professionals use contrast dyes. Healthcare professionals administer it intravenously, highlighting the blood vessels and making the aneurysm more visible in imaging tests.
CT angiography is a specialized CT scan that uses contrast dye to get a highly detailed and three-dimensional view of the aorta, allowing for precise assessment and measurement of an aneurysm. For contrast-enhanced clarity, the contrast dye also aids in accurate diagnosis in magnetic resonance angiography.
Treatment Landscape
Medications are one non-surgical treatment option for aortic aneurysms. Blood pressure regulation is crucial as hypertension is a risk factor for developing aneurysms. Beta-blockers and angiotensin-converting enzyme inhibitors can help maintain healthy blood pressure, reducing the risk of aneurysm growth.
Making lifestyle changes like quitting smoking, maintaining a healthy diet, and regularly exercising can effectively slow down the growth of an aortic aneurysm and lower the chances of it rupturing. People diagnosed with aortic aneurysms should undergo regular checkups to detect any aneurysm growth. These checkups may include physical examinations, ultrasound scans, or CT scans.
Minimally invasive endovascular repair is a revolutionary option for treating aortic aneurysms if needed. More significant or high-risk aneurysms may necessitate open surgical closure. In certain instances, a healthcare professional may use a combination of open surgical repair and endovascular procedures. This hybrid approach attends to the individual patient’s requirements and the aneurysm’s complexity.
Delving into Aortic Aneurysm Surgery
Endovascular repair with stent grafts and open procedures are the two most common surgical procedures for aortic aneurysms. Patients and healthcare professionals must comprehend the crucial distinctions.
A stent graft is a metal mesh tube covered in fabric. Vascular surgeons use this to repair aortic aneurysms using a minimally invasive procedure called endovascular aneurysm repair (EVAR). During EVAR, a slender catheter is inserted through an artery in the groin and threaded up to the aneurysm. Once implanted, the stents establish a new blood flow route that bypasses the weakened portion of the aorta. It lowers the likelihood of an aneurysm rupturing.
This method involves making small incisions, which leads to a less painful and faster recovery than open surgery. On the contrary, open surgical repair necessitates a bigger incision in the chest or abdomen and is used for complicated cases where endovascular repair is impossible.
The Surgical Procedure
Commonly, healthcare professionals use general anesthesia during aortic aneurysm surgery. Inducing unconsciousness enables the patient to remain pain-free and oblivious throughout the procedure. Spinal anesthesia for aortic aneurysm surgery is less common, but surgeons may prefer it for patients with certain medical conditions, such as severe pulmonary disease.
Aortic aneurysm surgery often involves a collaborative effort among healthcare professionals, including vascular surgeons, anesthesiologists, and nurses, to provide comprehensive care. A vascular surgeon is a doctor who specializes in surgery of the blood vessels. Vascular surgeons can perform all types of aortic aneurysm surgery, including open surgery and EVAR. Their expertise is crucial in ensuring a successful surgical outcome.
A secure closure using the appropriate suture is essential to prevent bleeding, infection, and other complications following surgery. There are many different types of sutures available, and the type of sutures used will depend on the location of the incision and the type of surgery performed.
Surgeons may use absorbable or non-absorbable sutures. Absorbable sutures gradually dissolve over time, while non-absorbable sutures may require removal. Sutures can be monofilament (single-stranded) or multifilament (braided). Monofilament sutures are less likely to harbor bacteria, reducing the risk of infection.
Risks and Complications
All surgery carries risks, and aortic aneurysm surgery is no exception. Some of the most common risks and complications of aortic aneurysm surgery include bleeding, infection at the incision site, blood clots, damage to other organs, and graft failure.
A patient is also at risk of having endoleak, a complication of EVAR in which blood continues to flow into the aneurysm after applying the stent graft. Endoleaks can occur for various reasons, such as a leak in the stent graft or a tear in the wall of the aorta. If you have had EVAR, it is essential to follow your doctor’s instructions for monitoring for endoleaks.
Anticoagulants are medications that help to prevent blood clots from forming. Doctors often prescribe it to patients after aortic aneurysm surgery to reduce the risk of blood clots. Blood clots can pose a significant risk of stroke, making anticoagulants an essential part of post-surgical care.
Preparing for the Surgery
The journey begins with consulting a vascular specialist who will assess the patient’s condition, answer questions, and recommend the most suitable treatment, which may include surgery. A patient will undergo diagnostic tests, such as CT scans and ultrasounds, to provide a detailed picture of the aneurysm’s size, location, and severity.
Aortic dissection is a condition in which the inner layer of the aorta tears, allowing blood to flow between the layers of the aorta. Aortic dissection can be a life-threatening condition and requires immediate medical attention. Aortic coarctation is when the aorta narrows at a certain point. Aortic coarctation can cause high blood pressure in the arms and reduced blood flow to the legs.
Providing a comprehensive medical history and reviewing medications is crucial to ensure the surgical team is aware of potential complications or drug interactions. Patients should tell their doctors about all their medications, including over-the-counter and herbal supplements.
Post-Surgery: The Recovery Phase
The vascular surgeon will take the patient to the intensive care unit (ICU) for monitoring immediately after aortic aneurysm surgery. The healthcare professionals will prescribe pain medication to help control the pain, fluids, and electrolytes through an IV line. Once stable, patients may move to a regular room for further recovery.
Most patients recover from aortic aneurysm surgery within a few months. However, following the doctor’s instructions carefully during your recovery is essential. It includes getting plenty of rest, eating a healthy diet, and avoiding strenuous activity. There are also follow-up checkups to monitor healing and to check for any complications.
Managing the intimal layer after aortic aneurysm surgery is vital to prevent complications such as endoleaks and graft failure. Strict blood pressure control is necessary to protect the repaired aorta.
Testimonials and Case Studies
Maxx was a 10-year-old boy who suddenly experienced uncontrollable vomiting and could not move his legs and arms. His parents brought him to a hospital where he underwent a CT scan. The results showed that he had a massive brain bleed from a ruptured aneurysm. The doctors had no choice but to occlude the vessels for him to recover. His 72 hours after the surgery were the most critical. Luckily, he had no other medical complications, and his MRI and angiogram from his follow-up checkups show that his brain returned to normal.
Sandy was working on heavy equipment when he experienced a throbbing chest pain. His initial diagnosis was pneumonia. But when his doctors took an x-ray from a different angle, the images showed that he had a large descending thoracic aneurysm above his heart. His vascular surgeon did a stent graft in the morning, and Sandy woke up in the afternoon. The next day, he continued his recovery at home.
Medical Advancements and the Future
Researchers are developing 3D-printed stent graft guides customized to fit the individual patient’s anatomy. This innovation could improve the fit of the stent graft and reduce the risk of complications.
Fenestrated and branched stent grafts can treat complex aortic aneurysms that involve branch vessels. These stent grafts can help to preserve blood flow to the branch vessels while repairing the aneurysm.
In a clinical trial posted in the Journal of Vascular Surgery, ascending aortic aneurysm patients treated with Talent LPS had lower complications. Only one patient required immediate surgical conversion, and five needed late surgical conversions. No patients reported aneurysm ruptures after.
Conclusion
Aortic aneurysm surgery is an important treatment option for people with aortic aneurysms. They often develop without noticeable symptoms, silently growing and posing a grave risk. Surgery is a vital intervention to prevent rupture, which can be fatal. A successful surgery prevents rupture and sets the stage for recovery and a return to a healthy, active life.
Your health matters, and it’s worth prioritizing. By consulting with medical professionals, you take the first step towards a healthier, happier life.
References
Aneurysm Surgery: Traditional Open Surgery. Cleveland Clinic. Retrieved from: https://my.clevelandclinic.org/health/treatments/16735-aneurysm-surgery-traditional-open-surgery
Aortic Aneurysm. Centers for Disease Control and Prevention. Retrieved from: https://www.cdc.gov/heartdisease/aortic_aneurysm.htm
Aortic Aneurysm Treatment. National Heart, Lung, and Blood Institute. Retrieved from: https://www.nhlbi.nih.gov/health/aortic-aneurysm/treatment#:~:text=Your%20doctor%20first%20makes%20a,repair%20is%20about%20a%20month.
Criado, F. J., Fairman, R. M., Becker, G. J.Talent LPS AAA Stent Graft: Results of a Pivotal Clinical Trial. Journal of Vascular Surgery. Retrieved from: https://doi.org/10.1067/mva.2003.230
Endovascular Aneurysm Repair. UCSF Department of Surgery. Retrieved from: https://surgery.ucsf.edu/conditions–procedures/endovascular-aneurysm-repair.aspx
In the year 2020, I encountered one of the most significant challenges of my life when I was diagnosed with an ascending aortic aneurysm. This condition, considered one of the most severe and dangerous forms of cardiovascular disease, required immediate surgical intervention. The ascending aorta, which is the segment of the aorta that rises from the heart and delivers oxygen-rich blood to the body, had developed an abnormal bulge in its wall, known as an aneurysm. Left untreated, such an aneurysm could lead to life-threatening conditions such as aortic dissection or even aortic rupture.
In response to this urgent health crisis, I underwent emergency surgery, a procedure aimed to repair the dilated section of my aorta, thereby preventing a potential disaster. This type of surgery often involves a procedure known as an open chest aneurysm repair, where the weakened part of the aorta is replaced with a synthetic tube, a demanding operation that calls for extensive expertise and precision from the surgical team.
Surviving such a major health scare deeply impacted my life, leading me to channel my experience into something constructive and helpful for others going through the same situation. As a result, I took it upon myself to establish this website and a corresponding Facebook group. These platforms are designed to provide support, encouragement, and a sense of community for those grappling with the reality of an ascending aortic aneurysm.
I often refer to those of us who have had our aneurysms discovered and treated before a catastrophic event as “the lucky ones.” The unfortunate reality is that aortic aneurysms are often termed “silent killers” due to their propensity to remain asymptomatic until they rupture or dissect, at which point it’s often too late for intervention. Thus, we, who were diagnosed and treated timely, represent the fortunate minority, having had our aneurysms detected before the worst could happen.
Through this website and our Facebook group, I aim to raise awareness, provide critical information about the condition, share personal experiences, and, above all, offer a comforting hand to those who are facing this daunting journey. Together, we can turn our brushes with mortality into a beacon of hope for others.
Also, I make websites look pretty and rank them on search engines, raise a super amazing kid, and I have a beautiful wife.
