An aneurysm is a bulging of a weakened portion of a blood vessel's wall. The aorta the body's main blood vessel. It receives blood from the heart and delivers it to the body. An aortic aneurysm can lead to serious complications, such as rupture of the weakened wall, leading to life-threatening internal bleeding. Aneurysms can split the arterial wall, known as dissection, causing blood to flow between the layers of the blood vessel wall.
In either case, blood flow to the rest of the body can be interrupted, leading to serious complications and death. Treatment of aortic aneurysms involves medication to control blood pressure and surgery if the aneurysm is causing symptoms, is large, or growing rapidly.
Read on to learn about the treatment options for aortic aneurysm, including medications and surgical options.
How Is an Unruptured Aortic Aneurysm Treated?
Aortic aneurysms don't necessarily cause symptoms and can be present for many years before causing a problem. An unruptured aortic aneurysm might be noticed during diagnostic imaging tests performed for other conditions. If an aneurysm is discovered, you may be referred to a cardiologist and/or surgeons who specialize in blood vessel surgery. These healthcare providers can monitor the aneurysm's growth, prescribe medications to slow its growth, and recommend or perform surgery.
Thoracic Aortic Aneurysm
Your healthcare provider might prescribe the following medications:
- Blood pressure medications, specifically, beta-blockers or angiotensin receptor blockers (ARBS) to help lower blood pressure and slow aneurysm growth
- A statin to lower your cholesterol and reduce your overall risk of heart attack or stroke
- Acetylsalicylic acid (aspirin), especially if there is atherosclerosis or cholesterol plaque associated with the aneurysm
Whether or not surgery is recommended depends on the size of the aneurysm, the presence of symptoms, its rate of growth, and other risk factors. In general, for smaller aneurysms, your healthcare provider will order imaging tests such as ultrasound, computed tomography (CT) scans, or magnetic resonance imaging (MRI) every six months to one year to determine how fast it is growing and only intervene if an aneurysm grows beyond a particular size or is growing rapidly. Another important factor is where in the aorta the aneurysm is located.
If an aneurysm is large or growing rapidly, surgical repair is recommended to lower the risk of complications like rupture and dissection.
What Are the Types of Aortic Aneurysm Surgery?
There are two main ways to repair an aortic aneurysm surgically: open aneurysm repair and less invasive endovascular repair. The specific surgery depends on the surgeon's expertise, anatomic considerations, and other risk factors and conditions.
Open aneurysm repair
Open aneurysm repair is a major surgery performed under general anesthesia. In open repair, a surgeon makes an incision to open the chest or abdomen to directly access the affected portion of the aorta.
After clamping the aorta, the surgeon replaces the aneurysmal segment with a graft. Open anuerysm repair is a major surgery that has a significant recovery period and operative risk. However, outcomes are generally good in the long term with less need for re-operation.
Endovascular aneurysm repair (EVAR)
Open aneurysm repair was once the only option for aneurysm repair, but endovascular aneurysm repair (EVAR) is a less invasive option for some people. In EVAR, the surgeon gains access to the aorta through a blood vessel in the groin. Using catheters, a stent graft is placed in the affected portion of the aorta to seal off the aneurysm.
This surgery has a quicker recovery time and the risk of immediate complications is lower than open surgery. While some studies have shown that over the long term, EVAR is associated with more repeat operations and lower survival compared to open aneurysm repair, EVAR can be a great option for people who are at high risk to undergo open surgery or want to avoid open surgery.
What to Expect After Aortic Aneurysm Surgery
Open aortic surgery has a significant recovery period compared to EVAR. In open surgery, an incision in the chest or abdomen has been made, and it takes a couple of weeks for the wound to heal before stitches can be removed. You can expect to stay in the hospital for five to ten days. It's normal to feel tired and not up to doing much in the first couple of weeks after open surgery, and you will likely need to take at least two weeks off from work. You will probably return to performing your usual activities six weeks after surgery.
The recovery after EVAR is quicker, and you should be able to walk around the days after surgery, but you should take it slow. It can still take a few weeks to feel back to normal.
In either case, make sure to follow the instructions provided by your surgeon regarding care of your surgical wound and limitations for specific activities such as driving, walking, and restrictions on lifting and strenuous activity. Your surgeon may also prescribe certain blood thinning medications that can help keep your graft open. You will also receive information on taking antibiotics before certain dental procedures to prevent infection of the graft.
Factors Influencing Aortic Aneurysm Outcomes
Emergency Treatment for Ruptured Aortic Aneurysm
A ruptured aortic aneurysm is an emergency that requires immediate surgical treatment. In a ruptured aneurysm, the blood vessel wall has broken, leading to internal bleeding. This is a serious and life-threatening situation.
Treatment of a ruptured aortic aneurysm may be performed with an open repair or endovascular repair with placement of a stent, depending on the individual situation.
Signs of a Ruptured Aortic Aneurysm
If you have a known aortic aneurysm, seek medical attention immediately for these signs of ruptured aortic aneurysm:
- Sudden, severe pain in the chest, back, or abdomen
- Lightheadedness or dizziness
- Rapid heart rate
Lifestyle Changes
The following lifestyle changes can help lower the risk of aneurysm growth and prevent complications:
- Quit smoking
- Eat a heart-healthy diet
- Exercise regularly, performing moderate level of activity (avoid more intense exercise like weightlifting)
- Manage stress levels
Outlook for People With an Aortic Aneurysm
The prognosis of aortic aneurysm varies depending on the underlying cause, size, and other conditions. Over time, aneurysms get larger, and the bigger the aneurysm, the higher the risk of serious complications like rupture or dissection.
People with a small aneurysm that is stable in size and now growing might never require surgery or experience complications. On the other hand, those with larger aneurysms, and especially with uncontrolled high blood pressure, smoking, and certain associated conditions like Marfan syndrome or bicuspid aortic valve, the risk of complications is higher. Your healthcare provider can help guide risks and benefits of
When to Contact a Healthcare Provider
If you have an aortic aneurysm, it's important to follow up regularly with your healthcare provider for general screening and management of risk factors, and to monitor the aneurysm's growth. In addition if you develop symptoms of complications like rupture or dissection, such as lightheadedness, rapid heart rate, or severe chest, back or abdominal pain, you should seek immediate treatment in an emergency room.
Summary
An aortic aneurysm is a bulging of the wall of the body's main blood vessel due to the weakening of the blood vessel wall. These aneurysms risk major life-threatening complications such as rupture or dissection. A higher risk of complications is seen in large or rapidly enlarging aortic aneurysms, uncontrolled hypertension, and smoking.
Medical treatment may include blood pressure medication, cholesterol-lowering medication, and aspirin. Options for surgical treatment for symptomatic, large, or expanding aneurysms include open surgical repair or the less minimally invasive option of EVAR.