Aneurysms occur when the walls of an artery in the body weaken, allowing the artery to develop a bulge or balloon. Left undetected, aneurysms may continue to grow and become more likely to rupture, creating massive internal bleeding that requires immediate medical attention.
Aneurysms can form in any artery of the body but abdominal and thoracic aortic aneurysms can be among the most serious because they occur in the aorta, the largest artery in the body that distributes blood from the heart throughout the body.
The George Washington University Hospital offers minimally invasive procedures to treat complex aortic aneurysms, as well as other aortic conditions such as dissections (tears) and ruptures.
Aortic aneurysms may go undetected, but some people may notice a pulsating feeling near the navel, or tenderness or pain in the chest or abdomen or back pain.
People age 65 and older are more likely to develop abdominal aortic aneurysms. Aortic aneurysms are the tenth leading cause of death in men between the ages of 65 and 74, according to the American Medical Association.
According to the National Heart, Lung, and Blood Institute, the following may increase your risk for an aortic aneurysm:
- Gender: Men are more likely than women to have abdominal aortic aneurysms.
- Age: Abdominal aortic aneurysms are more likely to occur in people who are 65 or older.
- Smoking: Can damage and weaken the walls of the aorta. 90 percent of people with aneurysms have smoked.
- Family history: People who have family histories of aortic aneurysm are at higher risk of having one themselves, and are more likely to have one before age 65.
The treatment of an aneurysm is dependent on a number of factors, including the size of the aneurysm and the medical history of the patient. Physicians may recommend that smaller aneurysms be left alone and watched. However, when an aneurysm grows larger there is always a chance that it can rupture.
Previously, the treatment for such aneurysms was open surgery using large incisions, with longer hospital stays and recoveries. Now, interventional radiologists can perform a procedure called minimally invasive stent-graft repair. During this procedure, a catheter is threaded from the patient’s groin through the blood vessels up to the aorta. By watching on an X-ray screen, physicians are able to visualize the vessel anatomy and thread the stent-graft to the site of the aneurysm. When surgeons reach the correct location, they deploy a small synthetic graft within the aorta to divert the blood away from the weakened areas and restore normal blood flow. Patients typically stay in the hospital overnight and have a faster recovery than with open surgery.
Abdominal Aortic Aneurysm
Abdominal aortic aneurysms are the most common of all. They most often occur below the renal arteries. The risk of aneurysm rupture is one percent when the aneurysm is less than 5 centimeters but increases to 10 percent when between 5-6 cm. Surgery is recommended when it reaches 5 cm.
Endovascular Repair (EVAR)
This minimally invasive procedure involves the placement of a covered stent to reline the aneurysm and to keep it from bursting. Stent graft repair is less invasive than open surgery and often results in faster recovery times.
During this procedure, an aortic graft is sewn in place to replace the weakened segment of artery and keep it from bursting. Open repair is the standard for patients who don’t have suitable anatomy for endografts. The surgical team works closely with anesthesiologists and intensivists to provide the best post-operative outcomes.
Descending Thoracic Aneurysms
Descending thoracic aneurysms are confined to the thoracic aorta. Endovascular repair (TEVAR) is the first line therapy. This procedure is technically simpler than the standard EVAR since the graft is strictly a tube graft.
Thoracoabdominal aneurysms involve the visceral aorta and could extend from the entire aorta distal to the left subclavian artery. Open repair of this aneurysm is technically a very complex procedure that is performed in a few centers nationwide, including the GW Hospital.
Aortic Arch Aneurysms
When the aneurysm is present in the aortic arch. Treatment is safer because of the lack of need for the heart-lung machine during the endovascular procedure.
Aortic dissection is spontaneous tearing of the aortic wall due to either connective tissue disorders such as Marfan Syndrome or malignant, uncontrolled hypertension. Type A dissection involves the ascending aorta and requires emergent endovascular surgical repair. Type B dissection occurs distal to the origin of the left subclavian artery.