An aortic aneurysm is an abnormal enlargement, or bulging, of the wall of the aorta, the largest blood vessel in the body. As an aortic aneurysm grows, the walls of the aorta can be stretched thin, tense and weakened. If an aneurysm ruptures or tears, life-threatening internal bleeding can result.
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Fortunately, if detected in time, an aneurysm may be repaired with traditional surgery and minimally invasive techniques. The best approach for repairing an aortic aneurysm is influenced by the location, size and size of the aneurysm, as well as the patient's physical condition.
Aortic Aneurysm Diagnosis
Because aortic aneurysms frequently do not exhibit symptoms, they are often discovered during a periodic physical examination, or in an examination involving another health concern. A routine chest X-ray, for example, may show a large aneurysm.
If a patient appears to have an aneurysm, further testing may be ordered to determine the size and location of the aneurysm. These tests include CT scans, magnetic resonance imaging (MRI), transesophageal echocardiogram (TEE), abdominal ultrasound and angiography. Learn more about these and other diagnostic heart tests performed at John C. Lincoln.
A small aneurysm may require an observational, watch-and-wait approach: A physician may want to have imaging tests performed regularly, to monitor changes in the aneurysm's size and plan for future surgical intervention. Typically, an aortic aneurysm will not be operated upon unless it has reached a size of 5.6 centimeters, is growing rapidly, is causing pain or has begun to rupture.
In the meantime, a patient may be prescribed blood pressure medication to ensure that undue pressure is not placed on the weakened area of the aorta. The patient may be asked to limit physical activities, such as heavy lifting.
Aortic Aneurysm Surgery
The objective of aortic aneurysm surgery is to prevent the aneurysm from rupturing. Surgical techniques range from traditional, open-chest procedure to a newer, less invasive approach.
Traditional open surgery begins with a long incision in the chest or abdomen is opened, so that affected area of the aorta is made visible. Next, the heart is stopped, and a heart-lung machine is connected to the heart to mechanically clean and circulates blood to the rest of the body. Clamps are then placed above and below the diseased area of the aorta, which is cut and removed. Finally, a synthetic tube, or graft, is sutured into the aorta, in place of the removed section and the chest is closed.
The less invasive approach, called endovascular aneurysm repair or endovascular stenting, can be used in a limited, but growing number of situations. Endovascular stenting does not require a large incision, and it results if fewer complications and a shorter recovery time.
To perform endovascular stenting, catheters (thin, flexible tubes) are inserted through the groin, and a stent-graft — a woven tube surrounded and supported by a metal mesh — is guided along the blood vessel to the site of the aortic aneurysm. To locate the aneurysm, the catheter will inject a contrast dye that is read by a high-resolution X-ray machine.
At the appropriate location inside the aorta, the stent-graft is expanded and set into place with metallic hooks. In effect, the stent-graft assumes the pressure exerted by blood as it travels through the aorta.
Additional, Related Procedures
In some cases, patients will have an aortic aneurysm along with another heart condition. For example, a patient with a thoracic aortic aneurysm (in the upper chest) may also suffer from a diseased aortic valve — leaking blood back into the atrium, causing strain on the heart. In such situations, heart valve surgery may be performed at the same time as an open-chest aneurysm repair.