Healthy Living

Does Aneurysm Require Surgery?

Does Aneurysm Require Surgery?

Key Takeaways

  • Aneurysm could exist in a person for a long time without showing any symptoms and without being diagnosed.
  • In some cases treatment of aneurysm could even require an open surgery.
  • Surgery for treating an aneurysm formed in the brain is only reserved as an option for cases in which there are high chances of a rupture. 

An aneurysm is the formation of a bulge when the walls of the arteries weaken. It is an artificial condition and can remain undetected for years. If it gets ruptured, it could lead to a lot of complications and at times even death. Given below are few figures of the deaths caused by different types of aneurysms.

  • There are around 25,000 deaths caused by aortic aneurysm in America every year.
  • Approximately 30,000 brain aneurysms rupture every year in America and from that 40% die due to this illness.

An aneurysm can be formed in any artery including the important ones. The two most important arteries where aneurysm is formed are:

  • The artery which directly leaves the heart and this is termed as an aortic aneurysm. This is the most common location for aneurysms to occur. Aortic aneurysms are of two types namely thoracic (formed in the chest cavity) and abdominal (formed in the abdomen).
  • The artery which is in the brain is termed as a cerebral aneurysm.

Causes of Aneurysm

The exact reason of how an aneurysm is formed is not clear but there are several factors that can cause aneurysms. For instance, a ruptured tissue in the arteries can be responsible for the formation of an aneurysm. The arteries can be weakened by blockages caused by fatty deposits due to which the heart will have to pump harder to allow the blood to flow past the fatty deposits. This pressure can weaken the arteries causing an aneurysm.

Symptoms of Aneurysm

In many cases, aneurysms do not cause any signs or symptoms. Even though an aneurysm has not ruptured, a big aneurysm can block the circulation of the other tissues. An aneurysm can also lead to the development of blood clots which will gradually have an impact on the smaller blood vessels. This can cause a condition known as ischemic stroke or some other complications.

In cases of abdominal aneurysms, there can be certain signs and symptoms if it is growing fast. The people with abdominal aneurysm complain of abdomen pain that extends to the lower back. Also, the thoracic aneurysm can damage other tissues which are placed nearby including the nerves and blood vessels which can cause some symptoms.

When the aneurysm squeezes specific nerves it can cause a chest or back pain and other symptoms like coughing, breathlessness and problems in swallowing food. Also, when the coronary artery gets compressed a chest pain is felt.

Aneurysm causes more signs and symptoms when the bulge gets ruptured. This include:

  • Bleeding
  • Pain
  • Dizziness
  • Increase in the heart rate
  • Low blood pressure

Complications of Aneurysm

In cases where the aneurysm remains undetected, the initial signs are visible when there is a complication- mainly a rupture. The symptoms caused are mainly due to the rupture and not the aneurysm. It is very important to treat the complications promptly because they can turn fatal if left untreated. Some of the complications are,

  • Basis where the clot has traveled to, thromboembolism can lead to pain in the abdomen. If the clot moves to the brain, it can cause a stroke.
  • Severe chest and back pain can be caused due to an aortic aneurysm.
  • Angina – In some type of aneurysms.
  • A sudden and severe headache when brain aneurysm causes subarachnoid hemorrhage.

Treatments for Aneurysm

In cases where the aneurysm is silent, no active treatment is required. But if it gets ruptured, emergency surgery is the option for reducing complications.

The other treatment options include medication to treat the causes like high blood pressure and high cholesterol. Also, some specific beta-blockers may be prescribed to lower the blood pressure. When the blood pressure is lowered, the risk of the aneurysm getting ruptured is reduced.

Aortic Aneurysm Treatment Options

Abdominal aortic aneurysm refers to an enlargement or swelling in the abdominal part of the aorta, the large blood vessel that carries blood from the heart to different parts of the body. Aorta is about the thickness of a garden hose and tit travels from the heart through the center of the abdomen and chest. The development of aneurysm can occur anywhere along the aorta. When it occurs in the upper part of the aorta which is in the chest then it is known as thoracic aortic aneurysms.

However, on a common basis, aneurysms are known to form in the lower part of the aorta and thus are called as abdominal aortic aneurysms which can also be referred to as AAA. The aneurysm may range from small (about 1.6 inches) to large (more than 2.2 inches). The swelling may remain the same without any changes, but in some it may grow rapidly and start leaking. Abdominal aneurysms may not show symptoms until it becomes large and patients may not be aware of its existence.

The abdominal aortic aneurysms often grow very slowly without the presence of any symptom. This would make it difficult while diagnosing. There can be cases when some of the abdominal aneurysm would stay as it is without getting ruptured. Aneurysms start slow and grow gradually but in few cases they would start small and remain small throughout. It gets difficult to predict on fast does an abdominal aortic aneurysm grows. But as the aneurysms grow, it results in symptoms including:

  • Pulsating feeling in the abdominal region, often near the navel
  • Persistent back pain and/or abdominal pain
  • A dull, persistent, throbbing pain on the sides of the abdomen
  • Pain in the groin, which is not relieved with pain killers

Treatment of this condition is based on the size and growth of the aneurysm. Watchful waiting is the recommended treatment for small aneurysms in the range of 1.6 inches. Patients should have an ultrasound scan, once every 6 months, for review of symptoms and to observe the growth of the aneurysm. In general, surgery is not recommended for small aneurysms.

Aneurysms that are in the range of 1.6 to 2.1 inches may also not need a surgery. Watchful waiting is often recommended as the risk of surgery is more when compared to that of the aneurysms. Large aneurysms that are growing fast need a surgical repair of the wall. Large aneurysms are more than 2.2 inches in size and grow more than 0.5 cm within six months. Surgery replaces the weak portion of the aorta with a graft that prevents rupture.

In the case of thoracic or abdominal aortic aneurysm, there may not be a need for active treatment as long as it is not ruptured and monitored regularly. Certain medications and preventive measures can be followed. But if the aortic aneurysms are ruptured it needs an emergency surgery. Thoracic and abdominal aortic aneurysms can be fatal if not treated on time.  The decision as to whether one can conduct a surgery on an aneurysm that is not ruptured depends on various factors based on the patient and the characteristics of the aneurysm.

  • Individual factors – Age, gender, health, medical condition and the individual choice of the patient to go on with the surgery.
  • Aneurysm’s characteristics – Size, location and the speed at which the bulge is growing.
  • Other Factors – Continuous pain in the abdomen or other complications like thromboembolism will make surgery the right option for treating the aneurysm.

An aortic aneurysm which is of a very large size (2 inches or 5cm in diameter) or an aneurysm which is growing rapidly (slightly lesser ¼ inch in the past 6 months or 1 year) is better to be treated with a surgery.

In both cases, whether the aneurysm is ruptured or not, the surgery can be conducted in two ways:

  • Open surgery – in this procedure, the surgeon replaces the damaged portion of the aorta with a graft through open surgery. This method has a good success rate, but the recovery period is long. Patients return to normal activities within 2 to 3 months after the surgery.
  • Endovascular stent-graft surgery - it is a less invasive procedure when compared to open surgery. In this method a synthetic graft is placed in the damaged portion of the aorta using a catheter. Recovery time for this procedure is shorter.
    The type of surgery depends on a number of factors like age, other complications, and location of the aneurysm.

Over a period of time, endovascular surgery has become the preferred option due to the following reasons:

  • Less operative time
  • Shorter stay in hospital
  • Superior levels of surgical experience
  • Perceived lesser chances of disease or death
  • Lesser risk of scarring, infection and other problems

But, there are certain risks linked with endovascular surgery for repairing aortic aneurysm which include:

  • Loss of blood around the graft which may require another surgery
  • Loss of blood before and after the surgery
  • Blockage of the stent
  • Damage to the nerve
  • Kidney failure
  • Less flow of blood to the legs, kidney or other parts
  • Slippage of the stent

Cerebral Aneurysm Treatment Options

Surgery for treating an aneurysm formed in the brain is only reserved as an option for cases in which there are high chances of a rupture. The aneurysms in the brain that are less likely to be damaged or ruptured are not treated with a surgery due to the risk of a brain damage which can be caused by the complications associated with the surgery.

If surgery is not the option the patients will be provided with all the necessary information on how to monitor their condition and take preventive measures to avoid a rupture.

In cases where a damaged brain aneurysm has caused subarachnoid hemorrhage, it has to be treated as an emergency situation. The patient will have to be admitted to the hospital immediately to undergo a brain surgery.  During the surgery, the surgeon will seal the artery that has been damaged due to the aneurysm to prevent another bleed.

Popliteal Artery Aneurysm

 An abnormal bulge that occurs in the wall of the artery that runs through the area behind your knee is called popliteal artery aneurysm. The popliteal artery which is also the peripheral artery is the most commonly affected aneurysmal degeneration. When we say the term aneurysm, it would mean a weak area of the artery which bulges or expands to reach over one and half times its average normal diameter.

When we talk about the popliteal artery aneurysm then it can be defined as a popliteal artery diameter which is in excess of 2cm. The wall of the aneurysm will continue to be weak and also the size of the aneurysm will continue to grow. Most of the people with popliteal artery aneurysm do not have any symptoms, but often the symptoms include:

  • pain behind the knee,
  • foot pain,
  • an edema (collection of watery fluid) in the lower leg,
  • ulcers on the skin of the feet that don’t heal.
  • Reduction in the circulation which can occur gradually or on a chronic basis.
  • Acute ischaemia along with severe pain in the onset of the foot.

Formation of clots are quite common on the luminal lining of the wall of the artery in the aneurysmal area. This clot can later disperse into the smaller run off arteries of the limb and completely block them. However, the risk here is that flow of blood to the foot can be significantly impacted and reduced thus threatening the viability. The treatment for popliteal artery aneurysm is surgery. Your surgeon will create a bypass around the artery where the aneurysm is found and by drinking medication to reduce your risk of high blood pressure.

Once there is confirmation of the presence of popliteal artery aneurysm, the doctor can decide whether to repair it at that time. Each of the case in such condition is different from person to person. It would be ultimately the decision of the doctor as to whether to get it repaired or keep a close follow-up and observation. There are multiple issues which has to be considered by the doctor, they are size of the aneurysm, presence or absence of any blood clot within the aneurysm, arteries condition both above and below the aneurysm and lastly but most importantly the overall health of the individual who has this aneurysm.

Repairing using the surgical method is usually quite successful and also durable. But this surgical process has to be performed with minimal amount of risk. One of the best repair procedure would involve incision on the leg, after which get the popliteal artery aneurysm removed and then reconstruction of the flow of blood to the foot using either a vein or taking help of an artificial artery. In couple of years, doctors recommended to go in for stent grafts so as to get the popliteal artery aneurysm repaired. This is mostly considered for those patients who are not good risks for the common standard type of surgical repair.

Mostly the consensus is that if the aneurysm is causing symptoms then it should be treated and that it should be greater than 2cm in diameter. There are two method of repairing which would depend mainly upon anatomic and the morphological features of the aneurysm. Presently the techniques are open repair and secondly endovascular treatment.

Prevention of Aneurysm

The most important preventive measure to reduce the chances of getting an aneurysm is to stop smoking. It is not only the main risk factor for the formation of aortic aneurysm, but is also the biggest risk factor for the growth and damage of aneurysm. The other preventive measures are:

  • Eating  a healthy diet with lot of fruits, vegetables and whole grains.
  • Eating meat and poultry low in saturated fat and cholesterol.
  • Dairy products with less fat content.
  • Exercising regularly. For example, engaging in cardio exercises which are good for the blood circulation and flow of blood to the heart, arteries and other blood vessels.
  • Meet the doctor for annual checkups.