Aortic Aneurysms

An aortic aneurysm is a ballooning of the wall of the aorta. The aorta is a large artery that carries oxygen-enriched blood from the heart to the body. Aneurysms can occur along the length of the aorta as it runs from the heart, through the chest and down through the abdomen. An aneurysm that occurs in the abdomen is known as an abdominal aortic aneurysm (AAA). If the aneurysm occurs in the chest, it is called a thoracic aortic aneurysm (TAA). Both are very dangerous conditions that require careful monitoring and sometimes medication or surgery.

There is evidence that TAAs are closely connected to such diseases as high blood pressure, atherosclerosis (hardening of the arteries), Marfan syndrome and chronic infections such as syphilis or tuberculosis. The causes of AAAs may include atherosclerosis, genetic abnormalities or possibly a malfunction of certain tissues resulting from inflammation. The dangers of both types of aneurysms also are aggravated greatly by smoking.

Most aortic aneurysms produce no symptoms, which partly explains why they are so deadly. Small aneurysms can be managed by controlling blood pressure, but larger aneurysms usually require surgery to prevent them from rupturing. When an aneurysm ruptures, it can cause massive internal bleeding – half of all patients with an aortic aneurysm rupture die before they reach the hospital. Most aneurysms are discovered during diagnostic testing or on screening exams with an ultrasound or a CT scan. Whether or not surgery is the answer depends on the size of the aneurysm and the risk profile of the individual. Once an aneurysm reaches 5 to 5.5 centimeters, surgical repair is considered.

Surgical treatment of this disease for many years was carried out through an open incision in the abdomen. This allows complete removal of the aneurysm with a replacement using a piece of tubing. The vascular surgeon clamps the aorta, the aneurysm is opened and the surgeon places a synthetic tube – called a graft – within the wall of the aneurysm to keep blood from flowing into the aneurysm balloon or sack. Blood flows through the graft, preventing pressure on the weakened wall of the aneurysm. Patients stay in the hospital for four to five days and usually take six to eight weeks to recover.

In recent years, vascular surgeons have developed a new approach that results in quicker healing and smaller incisions. This is called endovascular grafting. The aneurysm is repaired using remote technology passed through small incisions in the groin and up through the arteries. An X-ray is used to guide the catheter into the aneurysm. Once it is properly positioned, the catheter releases a stent-graft, a plastic arterial graft covered with a metal superstructure. Just as in open surgery, the device stops blood from flowing into the weakened arterial wall. Patients usually are released from the hospital after one to two days and return to full activity in two to three weeks.

The type of surgery depends on the size of the aneurysm, the patient’s overall health and the condition of the patient’s arteries.

To make an appointment with a Washington University vascular surgeon, please call (314) 747-VASC (8272).