An aneurysm is a weakened area of an artery that bulges or expands. The greatest concern with an aneurysm is that it may rupture. Aneurysms that rupture can cause severe internal bleeding, which can be fatal.
Most aneurysms occur in the aorta, the main artery that runs through the chest to the abdomen. There are two primary types of aortic aneurysms:
- An abdominal aortic aneurysm occurs in the part of the aorta that passes through the middle to lower abdomen.
- A thoracic aortic aneurysm occurs on the section of the aorta that passes through the chest cavity.
Aneurysms that occur in arteries other than the aorta are called peripheral aneurysms. These types of aneurysms most commonly develop in the legs.
Treatment of an aneurysm depends on its size and on the symptoms an individual may be experiencing. The goal of treatment is to prevent the aneurysm from rupturing or, in the case of a peripheral aneurysm, to prevent blood clots from developing. Aneurysms can be repaired or removed with traditional open surgery or with a minimally invasive procedure.
Why Choose The Ohio State University Wexner Medical Center?
The vascular surgeons at Ohio State’s Wexner Medical Center have extensive experience with traditional open repair of abdominal aortic aneurysms, including repair of complex cases. They also are expert at minimally invasive repairs, and have experience in the use of all of the available stent graft technologies available to treat a wide variety of aneurysms. Ohio State's participation in national clinical trials helps direct the development of the next generation of stent grafts for the treatment of aneurysms.
What Is Aneurysm Repair Surgery?
An aneurysm can be repaired with an endovascular stent graft or with open surgical repair. The best method to repair each aneurysm depends on factors such as the location and size of the aneurysm, as well as the overall health of the individual.
Endovascular repair makes use of a catheter that guides a stent graft through small incisions in the groin. The graft is inserted into the aneurysm and seals the aneurysm from within. This procedure can eliminate the need for open surgical repair.
Open surgical repair may be recommended if the aneurysm anatomy does not allow for endovascular repair. In this procedure, the damaged area is removed and replaced with a stent graft, which is made of synthetic material.
Aneurysms can be monitored or corrected surgically while the bulge is intact but require emergency surgery when they rupture. If your aneurysm is small, your physician may recommend watching and waiting, which means that you will be monitored every six to 12 months for signs of changes in the aneurysm size.
Why Have an Aneurysm Repair Surgery?
An aneurysm may or may not cause symptoms or problems. Aneurysms often do not cause symptoms and may be found incidentally during an examination for another condition. Physicians and patients must discuss and decide if the risk of surgery is less than the risk of possible bleeding if an aneurysm is not repaired.
A physician may recommend emergency surgery if an aneurysm causes symptoms, such as abdominal or back pain, because the aneurysm may be on the verge of bursting. A ruptured aneurysm is a very dangerous condition. Although it is possible to repair a ruptured aneurysm surgically, it is important to identify and treat aneurysms before a rupture occurs. An aneurysm that causes internal bleeding requires open surgery aneurysm repair.
What to Expect During Aneurysm Repair Surgery
Preparing for Your Procedure
Before surgery you'll meet with your physician to discuss your medical history, the medicines you take and any questions you have. Your physician may also schedule routine tests including:
- CT scan (computed tomography scan, also called CAT scan) – An imaging procedure that uses X-rays and computer technology to produce cross-sectional, detailed images of the body, including bones, muscles, fat and organs
- MRI (magnetic resonance imaging) – A noninvasive, sophisticated imaging procedure that uses large magnets and a computer to produce detailed images of organs and structures inside the body.
- Ultrasound – A test that uses high-frequency sound waves to evaluate blood flow in a vessel.
A vascular surgeon will give you instructions to follow before the surgery, such as fasting and when to stop taking medications you normally take.
During Your Procedure
There are two types of aneurysm repair surgeries. You and your surgeon will determine which procedure is right for your condition.
- Endovascular repair - During this procedure, repairs are made using small incisions in the groin to avoid a large abdominal or chest incision. Through the femoral artery in the leg, the surgeon inserts a catheter to position an artificial graft inside the artery. The stent graft provides a permanent alternative path for blood flow, bypassing the aneurysm.
- Open surgery repair - During this procedure, the surgeon makes an incision in the skin in the area above the aneurysm. Once the aneurysm is located, the surgeon places clamps on it, below and above the bulge. The surgeon cuts open the aneurysm and attaches an artificial graft to the sides of the artery. This tube connects the artery above and below the aneurysm. After the surgeon wraps the wall of the aneurysm around the graft, the clamps are removed to allow blood to flow.
After Your Procedure
You may be connected to the following equipment after surgery:
- A heart monitor
- Oxygen given through a tube in the nose and an oxygen monitor on your finger
- A Foley catheter, a tube that goes into the bladder to drain urine
- An intravenous line (IV) to provide fluids
Your physician may schedule you for an imaging study to make sure that your aneurysm is not redeveloping and that the graft is functioning properly.
You may stay in the hospital for seven to 10 days after your surgery, depending on the site of your incision and your general health. Your physician or vascular surgeon will give you any special instructions you need to follow after the surgery.