Aneurysm Disease
The aorta is your largest artery and it carries blood throughout all parts of your body. While in the chest, the aorta is called the thoracic aorta. When it reaches your abdomen it is called the abdominal aorta and supplies blood to the lower part of the body. The aorta splits in two in your abdomen and carries blood into each leg through the iliac arteries.
When a weak area of the aorta expands or bulges, it is called an aortic aneurysm. The pressure from blood flowing through your abdominal aorta can cause a weakened part of the aorta to bulge, like a balloon. Although this can happen to almost any artery in the body, it is most common in the abdominal aorta. Thoracic aortic aneurysms also are common.
Vascular surgeons treat both abdominal aortic aneurysms and thoracic aortic aneurysms. Aneurysms are a health risk because they can rupture, causing severe internal bleeding, which can lead to shock or even death.
While less common, aneurysms also can cause another serious health problem called embolization. Embolization occurs when a clot or debris forms inside the aneurysm and then travel to the blood vessels that lead to other organs in your body. If one of these blood vessels becomes blocked, it cause severe pain and lead to more serious complications such as limb loss.
Conventional surgery and minimally invasive (endovascular) procedures are the two most common treatment procedures for aortic and thoracic aneurysms, and UPMC’s vascular surgeons routinely perform both types of procedures
Aneurysm treatment
Aortic aneurysm disease is treated with open surgery or as an endovascular (minimally invasive) procedure. UPMC’s vascular surgery team is uniquely qualified to assess aneurysm pathology and decide on the patient’s best course of treatment – endovascular, open surgery or a combination of both.
Additionally, the nursing and support staff are specially-trained to guide the patient through recovery and follow-up and, along with the surgeons, continually work to make aneurysm treatment safer, easier, and more comfortable for patients.
Open surgical repair
When an abdominal aneurysm reaches approximately five centimeters (about two inches) in diameter, there is an increased risk of rupture and your vascular surgeon may recommend that you have an open aneurysm, or surgical aneurysm, repair. Smaller aneurysms also may be recommended if the aneurysm is causing symptoms or is enlarging under observation.
During an open aneurysm repair your surgeon makes an incision in your abdomen, and replaces the weakened part of your aorta with a tube-like substitute called an aortic graft. This graft is made of a strong, durable, man-made plastic material in the size and shape of the healthy aorta.
The tube takes the place of the weakened section in your aorta and allows blood to pass through it. Following the surgery, you may stay in the hospital for four to seven days and, depending upon your circumstances, you may also require six weeks to three months for a complete recovery. More than 90 percent of open aneurysm repairs are successful for the long-term with few complications.
Endovascular repair
Instead of open aneurysm repair, the vascular surgeon may consider a newer procedure called an endovascular stent graft, which is considered a minimally invasive procedure. Endovascular means that the treatment is performed inside your artery using long, thin tubes called catheters that are threaded through your blood vessels via small incisions made in your groin area.
During the procedure, the surgeon guides the fabric and metal tube called an endovascular stent graft (or endograft) to the site of the aneurysm using live x-rays. Like the graft used in the open surgical procedure, the endovascular stent graft also strengthens the aorta.
With a hospital stay of two to three days, your recovery time for endovascular stent grafting is usually shorter than with the open surgery. Endograft placement, however, requires more follow-up visits and CT scans to ensure that the graft continues to function properly. The endograft also is more likely to require periodic maintenance procedures.
Not all patients are candidates for the endovascular repair because of the extent of the aneurysm, its relationship to the renal (kidney) arteries, or because of other medical issues. A vascular surgeon can help you decide the best method of treatment for your particular situation.
UPMC vascular surgeons are among the most experienced both in the region and the nation, and are able to offer treatments that may not be available in other hospitals. An example of this is a “hybrid procedure” which is a combination of the open surgery and endovascular techniques.
The UPMC Vascular Surgery Department believes that the most important part of aneurysm repair is consideration of what is efficient, safe, and comfortable for the individual patient.
Thoracic aortic aneurysms (TAA) are dilations of the aorta within the chest and can cause jaw pain, back pain, or shortness of breath, although most have no symptoms. Surgeons consider repair when a thoracic aneurysm reaches six centimeters or more. Like the treatment of abdominal aneurysms, repairs are done either as an open surgical procedure or as an endovascular procedure.
The UPMC Division of Vascular Surgery was the first vascular surgical group in the region to offer minimally invasive thoracic aneurysm repair and because of this experience, our surgeons also offer open and endovascular surgery for thoracic aneurysms due to atherosclerotic disease, aortic dissection or trauma.
Open surgical repair
During open aneurysm repair, the surgeon makes an incision in your chest and replaces the weakened portion of your aorta with a fabric tube called a graft. The graft is stronger than the weakened aorta and allows blood to pass through it. Many patients who have a thoracic aortic aneurysm also have heart disease or involvement of the aorta adjacent to the heart. For extensive or complex thoracic aneurysms, heart surgery is sometimes required at the same time as open aneurysm repair.
Following the surgery, your hospital stay is typically five to seven days. If you have an extensive or complex case, or if you have other conditions such as heart, lung or kidney disease, you may require two to three months for a complete recovery.
Endovascular stent graft repair
Depending on the location and shape of the aneurysm, the vascular surgeon may consider an endovascular stent graft Instead of an open repair.
Endovascular means that the treatment is performed inside your body using long, thin tubes called catheters. The catheters are inserted through small incisions made in your groin, and sometimes your arms, and are guided through your blood vessels.
During the procedure, your surgeon will use live x-ray pictures viewed on a video screen to guide a stent-graft to the site of the aneurysm. Like the graft used in open surgery, this stent-graft allows blood to flow through your aorta without putting pressure on the damaged wall of your aneurysm and stops the aneurysm from rupturing. Over time, the aneurysm usually will shrink.
Endovascular stent-graft repair requires a shorter recovery time than open aneurysm repair, and your hospital stay usually is reduced to two to three days. This treatment may not be applicable to all TAAs, however, since the aneurysm must have a suitable shape to allow the stent-graft to be used effectively. With the endovascular stent-graft repair, it is particularly important that long-term follow-up with periodic scans of the aortic repair be done to ensure that the stent-graft is functioning properly. Sometimes further procedures are required to maintain the stent-graft if leaks develop or if it moves out of position.
For more information on aneurysm disease, visit the Society for Vascular Surgery’s website at www.vascularweb.org.