An aneurysm is a balloon-like bulge in an artery.Aneurysms can form in arteries of all sizes. An aneurysm occurs when the pressure of blood passing through part of a weakened artery forces the vessel to bulge outward, forming what you might think of as a blister. Not all aneurysms are life threatening. But if the bulging stretches the artery too far, this vessel may burst, causing a person to bleed to death. An aneurysm that bleeds into the brain can lead to stroke or death.

• Causes Of Aortic Aneurysm
• Picture Of Abdominal Aortic Aneurysm
• Abdominal Aortic Aneurysm Screening

Where do aneurysms occur in the body?. In the tiny arteries that supply blood to the brain (the cerebral arteries). In parts of the large vessel that carries blood from the heart to other parts of the body (the aorta). Aortic aneurysms can occur in the area below the stomach (abdominal aneurysms) or in the chest (thoracic aneurysms). An abdominal aortic aneurysm (AAA) is usually located below the kidneys.

Your browser does not support the NLM PubReader view. The documented risk factors for abdominal aortic aneurysm are advanced age, male sex (sex ratio. To the current Clinical Practice Guidelines of the European Society for Vascular Surgery (1). Quality of life following surgery for abdominal aortic aneurysm. Typically presents in men older than 50 years of age, with sudden onset of severe ripping or tearing substernal or interscapular pain. May present with syncope, heart/renal failure, or mesenteric or limb ischaemia; oxygen/advanced life support protocol and haemodynamic support should be institute. Abdominal aortic aneurysm (AAA) is a relatively common and often fatal condition that primarily affects older patients. AAAs accounts for 15,000 deaths yearly and in 2000 were the 10th leading cause of death in white men 65 to 74 years of age in the United States.1 With an aging population, the incidence and prevalence of AAA is certain to rise.

Causes Of Aortic Aneurysm

In the heart’s main pumping chamber (the left ventricle).Why do I need surgery?Different operations treat the different kinds of aneurysms. Surgery to treat aortic aneurysms, those that occur in the body’s main artery, depends on the size and location of the aneurysm and your overall health. Aortic aneurysms in the upper chest (the ascending aorta) are usually operated on right away.

Aneurysms in the lower chest and the area below your stomach (the descending thoracic and abdominal parts of the aorta) may not be as life threatening. Aneurysms in these locations are watched for varying periods, depending on their size. If they become about 5 centimeters (almost 2 inches) in diameter, continue to grow, or begin to cause symptoms, you may need surgery to repair the artery before the aneurysm bursts. What does the surgery involve?Surgery involves replacing the weakened section of the vessel with an artificial tube, called a graft.

This means that surgeons will have to open either the stomach area (for abdominal aneurysms) or the chest (for thoracic aneurysms).The cardiovascular surgeon leads the surgical team, which includes other assisting surgeons, an anesthesiologist, and surgical nurses. When the operation begins, the surgeon will make a cut (called an incision) either in the abdomen or the chest. The incision depends on where the aneurysm is located.Surgeons will then place clamps on the artery above and below the aneurysm to stop blood flow to that part of the aorta. Your heart and brain still get blood because other vessels take over.The bulging section of the aorta is cut out (excised).

The surgeon will then replace the missing piece with a fabric tube called a graft. The clamps are then removed slowly to allow blood to flow through the vessel again.Sometimes surgeons do not cut out the bulging section of the aorta. In these cases, the operation is the same except that surgeons place the fabric graft inside the vessel, like a lining, to decrease the pressure on the wall of the artery. This procedure is called endoaneurysmorrhaphy.If the aneurysm is located in the ascending aorta just above the heart, the heart-lung machine will be used.The surgery takes about 2 to 4 hours. Recovery timeYou can expect to stay in the hospital for 5 to 7 days, including at least 1 to 2 days in the Intensive Care Unit (ICU).You will be given medicines called, which help to control any fluid buildup after surgery.

You may also need to take aspirin for the first 6 weeks after surgery to stop any blood clots from forming. Life after aneurysm surgeryAfter aneurysm surgery, your doctor will recommend that you join a cardiac rehabilitation program. These programs help you make lifestyle changes such as modifying your diet, exercising to get your strength back, quitting smoking, maintaining a healthy weight, and learning to deal with stress.If you have an office job, you can go back to work in about 4 weeks. If you have a more physically demanding job, you may have to wait 6 to 8 weeks, or more.

Non-surgical repair of abdominal aortic aneurysmsCardiologists at the Texas Heart Institute were among the first to use a nonsurgical technique to treat high-risk patients with abdominal aortic aneurysms. This technique is useful for patients who cannot have surgery because their overall health would make it too dangerous.The procedure uses a catheter to insert a device called a stent graft. The stent graft is placed within the artery at the site of the aneurysm. The stent graft acts as a barrier between the blood and the diseased wall of the artery. The blood flows through the stent graft, decreasing the pressure on the wall of the weakened artery. This decrease in pressure can prevent the aneurysm from growing or bursting.Benefits of the procedure include no general anesthesia (you are awake for the procedure), a shorter hospital stay (about 24 hours), a faster recovery, and no large scars.

Time and experience will prove whether this procedure will eliminate the long-term risk of an aneurysm’s bursting.

An 82-year-old male with multiple medical problems was transferred from a community hospital with a ruptured large abdominal aortic aneurysm. He was deemed inoperable at the other hospital. He arrived to the University of Cincinnati Medical Center hybrid angiographic suite and was treated with an endovascular repair of his aortic aneurysm. (Above: Pre-intervention, Below: Post-repair).Endovascular repair of ruptured aortic aneurysms or aortic trauma repair has become the standard of care in recent years, overtaking the traditional open approach. This is secondary to both improved survival rate and less morbidity of this minimally invasive approach as compared to the open procedure. According to, director of University of Cincinnati Medical Center’s newly launched Aortic Center, to be formally dedicated sometime in 2015, “For a patient with a ruptured or transected aorta, time means life, and a protocol-based approach has shown to improve outcomes.” 1All hospitals in the Cincinnati, Ohio region send patients with an aortic aneurysm rupture or traumatic injury to the University of Cincinnati Medical Center, usually via Life Flight helicopter.

Jain explains, “We’ve developed a very aggressive protocol for these cases. When the patient lands at the helipad, they completely bypass the emergency room and within a few minutes after arrival, the patient is directly transported to the operating room. In the operating room, there is a team of vascular surgeons, anesthesiologists, nurses and X-ray technicians available and on call 24/7, ready to treat this patient.

Picture Of Abdominal Aortic Aneurysm

This contrasts with the more common scenarios, seen in most other hospitals, where patients are first evaluated in the ER, delaying OR entry.”At the University of Cincinnati Medical Center Aortic Center, all such patients first undergo endovascular aortic balloon occlusion to achieve hemodynamic stability. This procedure is accomplished expeditiously under local anesthesia within minutes of their arrival in the OR. The vascular surgical team then performs an angiogram, followed by endovascular repair if the patient’s aortic anatomy is appropriate.

Occasionally, cases convert to an open approach. Jain reports that the team performs an average of five to eight such emergency aortic repairs each month and adds, “Since instituting this more aggressive protocol, we’ve seen a real decrease in mortality in accordance with the published literature of about 80% survival. 2 For excellent results, it’s equally important to have a good critical care team that manages these patients pre-, intra- and post-operatively.” To successfully address a wide variety of trauma presentations, it is also key that surgeons have experience in performing both endovascular and open procedures. A major challenge going forward will be to ensure that the next generation of vascular surgeons remains well-trained in performing open surgeries as well.University of Cincinnati Medical Center is a level 1 trauma center and serves as a referral center for a large number of community medical centers across the states of Ohio, Kentucky and Indiana. Jain explains, “The patients involved in traumatic events like car accidents can sometimes have subtle injury to the inner lining of their thoracic aorta that could be overlooked at initial presentation but can present weeks to months later with aneurysmal degeneration.

Hence, all such patients should be followed at a dedicated vascular center with CT scan angiography to ensure stability of their initial small intimal injury.”Jain and colleagues are also performing complex non-emergent thoracic and abdominal aortic aneurysm and dissection repairs. He explains, “In order to reduce the number of surgical operations these patients undergo, we’ve been performing a larger number of hybrid repairs, where two different repairs are performed at a single time with simultaneous use of open and endovascular approaches.” While somewhat more complex, hybrid surgeries decrease risks for pulmonary and hemodynamic instability, as well as reduce recovery time and hospital resource usage. Jain notes, “The Aortic Center is fortunate to have a vascular surgical team with a wide breadth of expertise, including endovascular, open and laparoscopic repair techniques.

In this way, we can flexibly handle any cases that present to us using a variety of treatment approach options.”, professor, chief, and program director of vascular surgery, concludes, “This approach to the management of critical thoracic and abdominal aortic pathology is only available at a few sites nationally, of which the University of Cincinnati Medical Center is the only one regionally. Our system of aggressive care truly makes a lifesaving difference in many of these patients’ lives.”. References: 1. Darling 3rd, P.S.

Abdominal Aortic Aneurysm Screening

Kreienberg, et al. Endovascular repair of ruptured infrarenal abdominal aortic aneurysm is associated with lower 30-day mortality and better 5-year survival rates than open surgical repair. J Vasc Surg, 57 (2013), pp. Murad MH, Rizvi AZ, Malgor R, et al. Comparative effectiveness of the treatments for thoracic aortic transection.

53:193-199.e1-21.Amit Jain, MDAssistant Professor of SurgeryDivision of Vascular SurgeryDirector, Aortic Center, University of Cincinnati Medical Center(513) 558-5146.