An aneurysm is an abnormally widened and weakened section of a blood vessel wall.
Aneurysms most commonly form in the aorta, the body's largest artery that runs from the heart, through the chest and down into the abdomen.
Aortic aneurysms usually cause no symptoms until they rupture.
To prevent hemorrhage, or the sudden escape of blood when an aneurysm tears or bursts, physicians may need to surgically repair or remove an aneurysm.
Aneurysms can also cause symptoms by the compression of adjacent structures, a clot from the aneurysm moving downstream, or rupture into adjacent structures.
An aneurysm is an enlargement of a weak area of an artery. The pressure of blood flow can cause the weakened area to enlarge like a balloon to far beyond the normal diameter of the artery. Because aneurysms can burst or rupture, they are considered a serious health condition. Larger aneurysms are more likely to burst than smaller ones, resulting in internal bleeding that can be fatal.
The most common location of aneurysms is in the aorta, the body's largest artery, which runs from the heart, through the chest, and down into the abdomen. Other parts of the body that may also be affected by aneurysms include:
The thigh, knee, and groin;
The upper chest or shoulder;
The head and neck; and
The spleen, liver, kidneys, or stomach.
The cause of aneurysms is unclear. Some researchers believe that it may be associated with atherosclerosis (hardening of the arteries); others believe that the same risk factors that contribute to atherosclerosis, such as high blood pressure and smoking, may make arteries more vulnerable to aneurysms.
Surgical aneurysm repair is a complicated procedure usually performed under general anesthesia. Physicians have been performing aneurysm repair surgeries for many years, and the procedure's benefits and risks are well documented.
To surgically repair an aneurysm, doctors make an incision into the body to access the artery. Some aneurysms may be clipped or clamped at the point at which they emerge from the wall of the vessel. Other aneurysms may be repaired using grafts, or man-made synthetic-fabric patches or blood vessels that rebuild the blood vessel affected by the aneurysm.
An aneurysm of the popliteal artery in the knee. The dotted lines indicate where doctors might cut to remove the aneurysm and sew a healthy blood vessel graft in place to rebuild the artery.
WHEN IS THE PROCEDURE INDICATED?
Surgical aneurysm repair is usually performed to manage an aneurysm that has not yet ruptured or blocked an artery, which is called elective or early repair.
In most cases of elective aneurysm repair, size determines whether surgical repair is needed. Elective repair of aneurysms is also used to prevent blood circulation problems or reduce the risk of an arterial embolism, a small piece of loose plaque or a blood clot that can lodge in an artery.
Surgical aneurysm repair is also done in emergency situations when a person arrives at a hospital soon after a rupture has occurred.
Before performing surgery, physicians assess the extent, size, and exact location of an aneurysm using imaging tests, such as:
Magnetic resonance angiography (MRA);
Contrast arteriography, also called angiography (injecting a contrast dye into the arteries and then taking x rays); and
Computed tomography (CT) scanning.
When the fabric aortic graft is sewn in place, the wall of the aorta is closed around the graft to protect it.
WHAT TO EXPECT
The treatment strategy for each aneurysm is developed for each person based on factors such as the aneurysm's size, location, and estimated risk of rupture.
To access and repair an aneurysm, doctors make incisions in the skin and muscle above an artery. However, when physicians repair aneurysms located on blood vessels in the brain, they make the incision into the bones of the head.
Once the aneurysm site on the arterial wall is exposed, the artery is clamped above the aneurysm to prevent blood from flowing through the area. Physicians make an incision into the aneurysm and remove any clotted blood or plaque deposits. The section of artery affected by the aneurysm is then replaced with a tube-like blood vessel graft made of synthetic material in the size and shape of a healthy artery. One end of the graft vessel is attached to the wall of artery just above where the aneurysm began and the other end of the graft extends down through the artery to a point below the end of the aneurysm.
Physicians may also repair aneurysms with the following techniques:
Sewing a fabric patch into the artery wall;
Removing the aneurysm and reshaping the artery with a section of the patient's leg vein; or
Clipping, or placing a small clamp on the neck of the aneurysm to block blood flow and deflate the aneurysm.
Surgical complications during open surgery to repair an aneurysm vary depending upon which arteries are involved and a person's age and physical condition. Minor complications include:
System-wide infection or infections at incision sites.
More serious risks include:
Paraplegia, or paralysis;
Rarely, re-operation or death.
POST-PROCEDURE GUIDELINES AND CARE
After undergoing a surgical aneurysm repair, a person may stay in the hospital for up to 10 days. People who have had a brain aneurysm repaired may have to remain in intensive care for more than a week.
After discharge, it can take anywhere from 5 weeks to 3 months to fully recover from surgery.
The follow-up care for repaired aneurysms usually includes periodic monitoring, such as ultrasound scans to make sure that the repaired artery is functioning properly.
People who have had aneurysm repair surgery should alter their lifestyles to help ensure good long-term results of aneurysm repair. Changes that minimize the risk that atherosclerotic disease will affect the arteries include:
Eating foods lower in fat, cholesterol, and calories;
Exercising aerobically, such as brisk walking, for 20 to 30 minutes, five times a week; and