Does Aneurysm Require Surgery?
An aneurysm is the formation of a bulge when the walls of the arteries weaken. It is an artificial condition that can remain undetected for years. If it ruptures, it could lead to many complications and, at times, even death. The following are a few figures concerning the deaths caused by different types of aneurysms:
- About 25,000 deaths are caused by aortic aneurysms in America every year.
- Approximately 30,000 brain aneurysms rupture every year in America, and from that, 40% die from them.
An aneurysm can be formed in any artery, including the major ones. The two most important arteries where an aneurysm can form are:
- The artery that directly leaves the heart, which is called 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 in the brain, which is called a cerebral aneurysm.
Causes of Aneurysm
The exact reason why an aneurysm forms 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 due to blockages caused by fat deposits, which force the heart to pump harder to allow blood to flow past these fatty deposits. This pressure can weaken the arteries, causing an aneurysm.
Symptoms of Aneurysm
In many cases, aneurysms do not produce any signs or symptoms. Even if an aneurysm has not ruptured, a big aneurysm can block the circulation of other tissues. An aneurysm can also lead to the development of blood clots, which will gradually have an impact on smaller blood vessels. This can cause a condition known as ischemic stroke or other complications.
In the case of abdominal aneurysms, there can be certain signs and symptoms if it grows quickly. People with an abdominal aneurysm complain of abdominal pain that extends to the lower back. Also, a thoracic aneurysm can damage other tissues placed nearby, including the nerves and blood vessels, which can cause some symptoms.
When the aneurysm squeezes specific nerves, it can cause chest or back pain and other symptoms like coughing, breathlessness, and problems swallowing food. Compression of the coronary artery also causes chest pain.
An aneurysm produces more signs and symptoms when the bulge ruptures. These include:
- Bleeding
- Pain
- Dizziness
- Increased heart rate
- Low blood pressure
Complications of an Aneurysm
If the aneurysm remains undetected, the initial signs are visible only when there is a complication — mainly, a rupture. The symptoms caused are mainly due to the rupture, 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:
- Based on 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 by an aortic aneurysm.
- Angina (in some types of aneurysms)
- A sudden, severe headache when a brain aneurysm causes subarachnoid hemorrhage.
Treatment for Aneurysm
In cases where the aneurysm is silent, no active treatment is required. But if it ruptures, emergency surgery is the option for reducing complications.
Other treatment options include medication to treat causes like high blood pressure and high cholesterol. Also, some specific beta-blockers may be prescribed to lower blood pressure. When the blood pressure is lowered, the risk of an aneurysm rupturing is reduced.
Aortic Aneurysm Treatment Options
An 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. The aorta is about the thickness of a garden hose, and it travels from the heart through the center of the abdomen and chest. An aneurysm can develop anywhere along the aorta. When it occurs in the upper part (in the chest), it is known as a thoracic aortic aneurysm.
However, on a common basis, aneurysms are known to form in the lower part of the aorta and thus are called abdominal aortic aneurysms, which can also be referred to as AAA. The aneurysm can 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 they become large, and patients thus may not be aware of their existence.
Abdominal aortic aneurysms often grow very slowly without any visible symptoms. This makes it difficult to diagnose. There are cases where some abdominal aneurysms stay as they are, without rupturing. Aneurysms start slowly and grow gradually, but in a few cases, they can start small and remain small throughout. It becomes difficult to predict how fast an abdominal aortic aneurysm grows. But as the aneurysm grows, it results in symptoms such as:
- 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 painkillers
Treatment 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 six months to review symptoms and to observe the aneurysm’s growth. 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 surgery. Watchful waiting is often recommended, as the risk of surgery is greater compared to that of the aneurysm. Large aneurysms that grow quickly need surgical repair of the wall. Large aneurysms are considered bigger than 2.2 inches in size and grow more than 0.5 centimeters within six months. Surgery replaces the weak portion of the aorta with a graft that prevents rupture.
In the case of a thoracic or abdominal aortic aneurysm, there may not be a need for active treatment as long as it has not ruptured and is monitored regularly. Certain medications and preventive measures can be followed, but if the aortic aneurysm ruptures, it needs emergency surgery. Thoracic and abdominal aortic aneurysms can be fatal if not treated on time. The decision to conduct surgery on an aneurysm that is not ruptured depends on various factors based on the patient and the characteristics of the aneurysm itself.
- Individual factors: Age, gender, health, medical conditions, and the individual’s choice whether or not 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 that is very large in size (2 inches or 5 centimeters in diameter) or an aneurysm that is growing rapidly (slightly less than ¼ inch in the past 6 months or 1 year) is best treated with surgery.
In both cases, whether the aneurysm has ruptured or not, 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 usually return to normal activities within two to three months after the surgery.
- Endovascular stent graft surgery: This is a less invasive procedure 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 also shorter.
The type of surgery depends on a number of factors like age, other complications, and the 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 the hospital
- Superior levels of surgical experience
- Perceived lesser chances of disease or death
- Less risk of scarring, infection, and other problems
However, 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/or after surgery
- Blockage of the stent
- Damage to the nerve
- Kidney failure
- Reduced blood flow to the legs, kidney, or other parts
- Slippage of the stent
Cerebral Aneurysm Treatment Options
Surgery for an aneurysm formed in the brain is reserved only as an option for cases with a high chance of rupture. Aneurysms in the brain that are less likely to be damaged or ruptured are not treated with surgery due to the risk of brain damage, which can be caused by the complications associated with the procedure.
If surgery is not an option, patients will be provided with all the necessary information on how to monitor their condition and take preventive measures to avoid rupture.
If a damaged brain aneurysm has caused subarachnoid hemorrhage, it has to be treated as an emergency. The patient will have to be admitted to the hospital immediately to undergo brain surgery. During the procedure, the surgeon will seal the artery that has been damaged due to the aneurysm to prevent another bleed.
An abnormal bulge in the wall of the artery that runs through the area behind your knee is called a popliteal artery aneurysm. The popliteal artery, which is also the peripheral artery, is the most commonly affected aneurysmal degeneration. The term “aneurysm” refers to a weak area of the artery that bulges or expands to reach over one and a half times its average normal diameter.
A popliteal artery aneurysm then can be defined as having a popliteal artery diameter in excess of 2 centimeters. The wall of the aneurysm will continue to be weak and the size of the aneurysm will continue to grow. Most people with a popliteal artery aneurysm do not have any symptoms, but often, the symptoms that do appear include:
- Pain behind the knee
- Foot pain
- Edema (collection of watery fluid) in the lower leg
- Ulcers on the skin of the feet that don’t heal
- Reduction in circulation, which can occur gradually or on a chronic basis
- Acute ischemia along with severe pain in 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 runoff arteries of the limb and completely block them. However, the risk here is that the flow of blood to the foot can be significantly impacted and reduced, thus threatening its viability. The treatment for a popliteal artery aneurysm is surgery. Your surgeon will create a bypass around the artery where the aneurysm is found and will use medication to reduce your risk of high blood pressure.
Once the presence of a popliteal artery aneurysm is confirmed, the doctor can decide whether to repair it at that time. Each case varies from person to person, so it is ultimately the decision of the doctor whether to get it repaired or keep a close follow-up and observation. There are multiple issues that have to be considered by the doctor, namely, the size of the aneurysm, the presence or absence of any blood clot within the aneurysm, the condition of the arteries both above and below the aneurysm, and, most importantly, the patient’s overall health.
Repairing with the surgical method is usually quite successful and durable. But this surgical process has to be performed with a minimal amount of risk. One of the best repair procedures involves an incision on the leg, after which the popliteal artery aneurysm is removed and then reconstruction of blood flow to the foot is done using either a vein or an artificial artery. Some doctors recommend going in for stent grafts to repair the popliteal artery aneurysm. This is generally considered for patients who are not good candidates for the standard type of surgical repair.
The general consensus is that if the aneurysm is causing symptoms and is greater than 2 centimeters in diameter, it should be treated. There are two method of repairing which depend mainly on the anatomic and morphological features of the aneurysm. Presently, the techniques are open repair and endovascular treatment.
Prevention of Aneurysms
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 an aortic aneurysm, but is also the biggest risk factor for the growth and damage of the aneurysm. Other preventive measures are:
- Eating a healthy diet with lots of fruits, vegetables, and whole grains
- Eating meat and poultry low in saturated fat and cholesterol
- Consuming dairy products with a lower fat content
- Exercising regularly; for example, engaging in cardio exercises that are good for blood circulation and blood flow to the heart, arteries, and other blood vessels
- Meeting the doctor for annual checkups
