What is an Aortic Aneurysm? 

An aneurysm is an enlarged and weakened section of an artery. An aneurysm is a serious health concern, because as it increases in size, it can rupture. Besides rupturing, aneurysms carry another risk. Blood clots can form in an aneurysm and block blood flow to parts of your body.

• Most aneurysms occur in your aorta, which is the largest artery in your body. It runs from your heart through your chest and abdomen.

•  An aneurysm that occurs in your abdomen is called an abdominal aortic aneurysm (AAA). AAA is the most common type of aneurysm.

•  An aneurysm that occurs in your chest is called a thoracic aortic aneurysm (TAA).

• Aneurysms also occur in your thigh, your knee, your head or neck, or your spleen, liver, kidneys, or stomach.

• Not all aneurysms need immediate treatment. If your aneurysm is small, your physician might recommend "watchful waiting," which means monitoring your aneurysm for signs of problems, such as enlargement.

• "watchful waiting," means that you will be monitored every 6 months for signs of changes in the aneurysm. Your physician may schedule you for regular CT scans or ultrasounds to watch the aneurysm. This method is usually used for aneurysms that are smaller than 2 inches or 5 cm.

•  If you also have high blood pressure, your physician may prescribe blood pressure medication to lower your blood pressure and lower the pressure on the weakened area of the aneurysm.

•  When an aneurysm causes problems or grows to a size that it can threaten your health, your physician might recommend surgical aneurysm repair.

• In some cases, your surgeon may repair your artery using blood vessels from your body or synthetic fabric patches or tubes called grafts.

• In other situations, your surgeon may use clips or clamps to stop blood from flowing into your aneurysm.

What causes an abdominal aortic aneurysm?

• Physicians and researchers are not quite sure what causes AAA.

• The leading thought is that the aneurysm may be caused by inflammation in the aorta, which may cause its wall to break down.

• Some researchers believe that this inflammation can be associated with atherosclerosis (also called hardening of the arteries) or risk factors that contribute to atherosclerosis, such as high blood pressure (hypertension). In atherosclerosis fatty deposits, called plaque, build up in an artery.

• Over time, this buildup causes the artery to narrow, stiffen and possibly weaken.

 Besides atherosclerosis, other factors that can increase your risk of AAA include:

•  Being a man older than 60 years
• Having an immediate relative, such as a mother or brother, who has had AAA
• Having high blood pressure
• Smoking

• Your risk of developing AAA increases as you age. AAA is more common in men than in women.

When do I need  aneurysm repair?

• Your physician may schedule you for surgical aneurysm repair or you may need it in an emergency.

• Scheduled surgery is called elective repair. You may need elective repair if your aneurysm grows to a certain size, depending on where it is in your body, or if your aneurysm grows quickly.

•  Less commonly, you may also require elective repair if your aneurysm interferes with blood flow to a part of your body, such as your legs.

• You may need emergency surgery if your aneurysm is about to rupture or burst or it has already ruptured. Your physician may recommend emergency surgery if your aneurysm is causing symptoms, such as abdominal or back pain, because your aneurysm may be close to bursting.

What can I expect?

• First your physician asks you questions about your general health, medical history, and symptoms. In addition, your physician conducts a physical exam. As part of your physical exam, your physician will feel the skin above the suspected aneurysm and listen to your arteries through a stethoscope. Your physician will also want to know if and when your symptoms occur and how often.

• Next, your physician may order tests to measure the size of the aneurysm and determine its location. These tests usually include:

•  Duplex ultrasound
• Computed tomography (CT) scan
• Magnetic resonance angiography (MRA)
• Angiography
• Your physician or vascular surgeon will give you the necessary instructions you need to follow before the surgery, such as fasting. Usually, your physician will ask you not to eat or drink anything at least 8 hours before your procedure.

• Your physician will discuss with you whether to reduce or stop any medications that might increase your risk of bleeding or other complications.

What happens during surgical aneurysm repair?

• Your vascular surgeon will make an incision in your skin and muscle above the artery with the aneurysm. For AAA, for example, your surgeon will work through your abdominal wall. If your aneurysm is in your knee, your surgeon will operate in your leg. 

• Once your surgeon exposes the aneurysm site, he or she will clamp the artery above the aneurysm to stop blood from flowing through the area. Your surgeon next opens the aneurysm and removes the clotted blood and plaque deposits.

• Usually, your surgeon will not completely remove your aneurysm. Instead, he or she may cut through the wall of the artery and open it like a butterfly. He or she may then insert a graft that is the same size and shape of your healthy artery. Your surgeon will attach one end of this graft just above where the aneurysm begins and the other end below the end of the aneurysm.

• In some cases, your surgeon may remove the aneurysm and replace it with a piece of a vein from your leg, or a man-made graft, if necessary.

Am I at risk for Complications during the procedure?

• Being older than 80 may increase your chances of having complications during aneurysm surgery if you also have other serious health problems. If your general health is good, however, your age alone is not a reason to avoid necessary aneurysm repair.

• Other factors that increase your chances of complications include:

• Congestive heart failure
• Diabetes
• Cardiopulmonary obstructive disease (COPD), in which airflow through your lungs is decreased
• A previous heart attack
• Recurring chest pain, called angina pectoris

What can I expect after my aneurysm repair?

• After your surgery, you may stay in the hospital for about 7 to 10 days. Depending upon the location of your incision and your general health, you may require care in intensive care until you recover sufficiently.

• Your physician or vascular surgeon will give you any special instructions you need to follow after the surgery, such as not lifting anything more than 10 pounds, until your incision heals adequately.

• Periodically, depending upon its location, your physician may schedule you for an imaging study to make sure that your aneurysm is not redeveloping and that the graft, patch, or clips are functioning correctly.

 Are there any complications?

• You may have complications following any major surgical procedure.

• Less serious complications that you may experience following aneurysm surgery include swelling, respiratory or urinary infections, or infections at the incision site.

•  More serious complications that you may experience include:

• Heart problems
• Breathing problems
• Kidney problems
• Colon problems
• Paralysis in the lower half of the body is rare following abdominal AAA surgery but more common following extensive thoracic aortic aneurysm operations.
• Surgery for AAA can sometimes lead to scar formation that can interfere with the nerves that control the flow of semen into the penis as well as its erection. If you are a man, you might experience retrograde ejaculation or possibly difficulty with erection. Retrograde ejaculation means that the semen travels up into your bladder instead of coming out your penis, but it does come out later when you urinate.

• These complications are relatively unusual and must be balanced against the risk of not treating the aneurysm.