Aortic Aneurysm Treatment

Monitoring

If the aneurysm is small—less than 2 inches wide—and there are no symptoms, your doctor may recommend "watching and waiting." Regular checkups, including an abdominal ultrasound/echocardiogram, CT scan, or MRI scan, are recommended once or twice per year. During this time, medications may be prescribed to help control your blood pressure and lipid levels to slow the growth of the aneurysm and reduce your risk for rupture or dissection.

Medication

Medications have no direct impact on an aneurysm, except by controlling the conditions that promote aneurysm growth. If the aneurysm is small, medication may be recommended to control lipid levels and blood pressure.

Lipids are fats circulating in your bloodstream, also known as cholesterols and triglycerides. The ratio of low density lipoprotein cholesterol (LDL) to high density lipoprotein cholesterol (HDL) affects the risk of developing plaque in your arteries. Arterial plaque can promote development of aortic aneurysms and/or dissections. Ideally this ratio should be low—a low LDL coupled with a high HDL. Generic drugs used to control lipid levels and establish favorable LDL to HDL ratios include statins, cholestyramines, colestipol, or gemfibrozil.

Anti-hypertensives such as beta-adrenergic blockers (beta blockers) may also be used to lower blood pressure to help reduce the growth rate of aortic aneurysms. Beta blockers are a group of more than a dozen different drugs that slow the heart rate, decrease the blood pressure, and reduce the contraction strength of the heart. However, some people may not be able to tolerate the side effects, such as nightmares, impotence, and fatigue.

Open abdominal or open chest surgery

The current standard treatment for repairing a thoracic or an abdominal aortic aneurysm is surgically removing the weak section of the aortic wall and replacing it with a tube made of Dacron. The tube, also known as a graft, is spliced in and sewn in place with permanent suture material. Over time, the blood vessel's normal thin inner lining of cells grows over inside of the Dacron tube, making a durable conduit for blood flow. The operation to repair an aneurysm can be surgically complex, depending upon the location of the aneurysm.

Repairs along the ascending aorta are the most straightforward of thoracic aortic aneurysm repair procedures, with the surgeon using an incision in the front of the chest. During this open-heart procedure, the patient is placed on a cardiopulmonary bypass machine, which circulates oxygenated blood to the body while the surgeon replaces the diseased section of the aorta with a graft. In patients with a bicuspid aortic valve, a congenital defect of the valve between the heart and the aorta, the valve may also be repaired or replaced during the operation. Valve repair or replacement is recommended if the valve is leaking or narrowed, or the patient may elect to have the bicuspid valve replaced to avoid a second heart surgery in the future.