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Aortic Aneurysm Repair

By

Sarah Lewis, PharmD

What is an aortic aneurysm repair?

Aortic aneurysm repair is surgery to fix an aortic aneurysm. An aortic aneurysm is a weakened area in the aorta. Your aorta is the main blood vessel (artery) leaving your heart and passing down through your chest and abdomen (belly). With time, a weakened area can grow, stretch, and balloon outward. Left untreated, an aortic aneurysm can burst and bleed heavily. Aortic aneurysm repair prevents or treats this life-threatening condition.

Aortic aneurysm repair involves removing or reinforcing the diseased part of your aorta with synthetic material, called a graft.

Aortic aneurysm repair is a major surgery with serious risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all of your treatment choices before having an aortic aneurysm repair.

Types of aortic aneurysm repair

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The types of aortic aneurysm repair procedures include:

  • Abdominal aortic aneurysm repair (AAA repair) repairs an aortic aneurysm that occurs in the part of your aorta that is in your abdomen (belly). This is the most common type of aortic aneurysm.

  • Thoracic aortic aneurysm repair repairs an aortic aneurysm that occurs in the part of your aorta that is in your chest.

Other procedures that may be performed

Your doctor may perform other procedures in addition to aortic aneurysm repair. This is most common with thoracic (chest) aortic aneurysm repairs. 

Additional procedures may include:

  • Aortic valve repair or replacement, which you may need if the aneurysm is close to your heart. The aortic valve opens to allow blood to leave your heart and closes to prevent blood from flowing back into your heart.

  • Heart surgery, which you may need if heart disease has contributed to your aortic aneurysm

Why is aortic aneurysm repair performed? 

Your doctor may recommend an aortic aneurysm repair to treat an aortic aneurysm. An aneurysm is a weakened area in a blood vessel wall that widens and bulges. Over time, this weakened area can grow, stretch, and balloon outward. Aneurysms are serious health conditions because they can burst and cause life-threatening internal bleeding

Aneurysms can occur in any blood vessel in your body, but they most commonly occur in the aorta. Your aorta is the main blood vessel that carries blood from your heart. It passes down through the chest and abdomen (belly). A ruptured or burst aortic aneurysm is a medical emergency. Few people survive a ruptured aortic aneurysm. This is because it causes rapid, massive blood loss.

Atherosclerosis is the most common cause of aortic aneurysms. Atherosclerosis is a buildup of plaque inside arteries. It can lead to blood vessel narrowing and hardening of the arteries. This can weaken the wall of the artery. Other causes of aortic aneurysm include smoking, high blood pressure, trauma, and congenital (present at birth) defects.

Your doctor may watch your aneurysm over a period of time. Your doctor may prescribe medication to slow the growth of the aneurysm or lower your blood pressure. This reduces pressure on the aneurysm. 

Many aortic aneurysms eventually need surgical repair. Ask your doctor about all of your treatment options and the timing of your repair. Consider getting a second opinion if your situation is not an emergency before deciding on an aortic aneurysm repair.  

Your doctor may recommend aortic aneurysm repair if your aneurysm is:

  • Causing symptoms. Most aortic aneurysms do not cause symptoms. When they occur, symptoms of an abdominal aortic aneurysm may include abdominal (belly) pain, low back pain, or feeling your heartbeat in your abdomen. Symptoms of a thoracic aortic aneurysm may include chest pain, back pain, neck or jaw pain, coughing, hoarseness, and difficulty breathing. Having symptoms may be a sign that your aortic aneurysm is about to burst. This is a medical emergency.

  • Growing rapidly, about ¼ inch over the last six to 12 months

  • Interfering with blood flow to other areas of your body, such as your legs

  • Larger than two inches, or about five centimeters

  • Leaking blood into the layers of the walls of your aorta (aortic dissection)

  • Rupturing. A ruptured or burst aortic aneurysm is a medical emergency. Symptoms of rupture include severe and sudden abdominal or back pain, anxiety, nausea, vomiting, pale and clammy skin, dry mouth, excessive thirst, and signs of shock. Signs of shock include weakness, dizziness, fainting, shaking, sweating, and rapid heartbeat.

Who performs aortic aneurysm repair?

The following specialists commonly perform an aortic aneurysm repair:

  • Vascular surgeons specialize in the surgical treatment of blood vessel diseases.

  • Thoracic surgeons specialize in the surgical treatment of diseases of the chest, including the blood vessels, heart, lungs and esophagus. Thoracic surgeons may also be known as cardiothoracic surgeons.

Other specialists who repair aortic aneurysms include:

  • Cardiac surgeons specialize in the surgical treatment of heart and blood vessel conditions. Cardiac surgeons may also be known as cardiothoracic surgeons.

  • Interventional cardiologists specialize in diagnosing and treating heart disease using catheter procedures and radiological imaging.

  • Vascular and interventional radiologists specialize in the treatment of blood vessel and other conditions using catheter-based procedures and imaging techniques.

How is aortic aneurysm repair performed?

Your aortic aneurysm repair will be performed in a hospital using one of the following approaches:

  • Minimally invasive surgery (endovascular aortic aneurysm repair, or EVAR) involves inserting a catheter and guide wire through an artery in your groin or leg. Your doctor feeds or guides the catheter guide wire to the aortic aneurysm. The catheter tip has a deflated synthetic graft, which expands like a spring once the catheter is in place. The synthetic graft reinforces the walls of your aorta. Your blood now flows through the graft. Endovascular surgery generally involves a faster recovery, less pain, and less risk of complications than open surgery. This is because it causes less trauma to tissues and organs. It may be a good option if you are not a candidate for open surgery. However, it cannot repair all types of aneurysms.

  • Open surgery involves making a large incision in the chest or abdomen (belly). Your doctor removes the weakened part of your aorta and replaces it with a synthetic graft. Your doctor might also cut open the aneurysm and place the graft inside. Open surgery allows your doctor to directly see and access the surgical area. Open surgery generally involves a longer recovery, a higher risk of complications, and more pain than minimally invasive surgery. Open surgery requires a larger incision and more cutting and displacement of muscle and other tissues and organs than minimally invasive surgery. Despite this, open surgery may be a safer or more effective method for certain patients.

Your doctor will advise you on which procedure is best for you and how long you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different types of aortic aneurysm repair and ask why your doctor will use a particular type of procedure for you.
Types of anesthesia that may be used

Your surgeon will perform your aortic aneurysm repair using either general anesthesia or r