Aortic Aneurysm Treatment

Endovascular surgery

Endovascular surgery is a less invasive alternative to open abdominal or heart surgery that uses a catheter equipped with a stent graft to repair the aortic aneurysm. A national study conducted at medical centers throughout the United States indicates that endovascular repair of abdominal aortic aneurysms has fewer complications than open abdominal surgery. The procedure results in less blood loss, less trauma to the aorta, and fewer or even no days in the hospital's intensive care unit.

However, not everyone is a good candidate for this procedure. The choice between an open abdominal procedure and an endovascular procedure depends on many factors and is best determined by the medical team in consultation with the patient. Stent grafts are generally used in older patients because open abdominal surgery is riskier in this group and because the long-term outcomes of stent grafts are not as well understood.

In this procedure, a stent graft consisting of a polyester tube inside a metal cylinder is attached to the end of a catheter, a long, thin tube. The catheter is inserted into the bloodstream, usually through an artery in the leg. Watching the progress of the catheter on an X-ray monitor, the surgeon threads the stent graft into the weak part of the aorta where the aneurysm is located.

Once in place, the stent graft is expanded, reinforcing the weakened section of the aorta to prevent rupture of the aneurysm. The metal frame expands as if it were spring loaded, holding tightly against the wall of the aorta. The blood flows through the stent graft, avoiding the aneurysm. Blood flow to the aneurysm is cut off, typically causing the aneurysm to shrink over time. This technique avoids using a large incision in the abdomen and cutting away the damaged section of the aorta.

The success rate of stent grafts to treat abdominal aortic aneurysms has risen to 90 percent. Although the endovascular procedure reduces recovery time to less than two weeks as opposed to one to two months with open abdominal repair, it still carries risk. The most common complication of this procedure is an endoleak, when blood leaks from the graft into the body cavity. And because the procedure is relatively new, the long-term results are unknown. Patients who have repair of their aortic aneurysms with stent grafts will need to be evaluated every six months initially to ensure that no complications are developing.

Treatment of aortic dissections

Dissections can occur anywhere along the aorta, and treatment largely depends upon the location. Dissections involving the ascending aorta are usually treated with emergency surgery while those involving the descending thoracic aorta are treated with medication.

Medical treatment usually includes aggressive control of blood pressure and heart rate while the descending thoracic aorta heals. About 1 out of every 10 people dies during medical treatment of a descending thoracic aortic dissection. If surgery is required, the risk of dying is higher –– about 30 percent. Every effort is therefore made to treat these aneurysms with medication.

The operation for aortic dissection consists of replacing a portion of the aorta with a synthetic material. Surgical repair of a dissection in the descending thoracic aorta is complex with the best results achieved by surgeons who have special expertise in these procedures.