How Aortic Aneurysms Are Treated

The goal of aortic aneurysm treatment is to prevent rupture (bursting) of the blood vessel. The only way to prevent a rupture is with an elective (planned in advance) surgical procedure. Not everyone who has an aortic aneurysm needs surgery and, sometimes, careful monitoring is the best and safest approach. 

Treatment of a ruptured aortic aneurysm is an emergency that cannot be planned in advance. A ruptured aortic aneurysm is a fatal event if not treated immediately. Even with the best treatment, the mortality rate is exceedingly high. 

There is only one lifestyle factor that has been proven to have an impact on aortic aneurysms, and that is smoking. This means that if you have an aortic aneurysm and you smoke, quitting is the only "home remedy" that you can adopt. Smoking is the strongest risk factor for an aortic aneurysm and people who already have an aortic aneurysm have a much higher risk of rupture if they continue to smoke.

Control of high blood pressure with antihypertensive medications is the only method that may be able to reduce the risk of rupture if you have an aortic aneurysm. And even this is not strongly proven as a preventative strategy. 

If you have an aortic aneurysm, hypertension can make it worse. But, there are a number of effective medications that treat hypertension. 

Many people with aortic aneurysms need to have an elective surgical repair to prevent a rupture. The decision about whether you need a repair is a complex and very personalized decision. If your aortic aneurysm is large, if it is expanding relatively rapidly, or if it is causing abdominal or back pain, surgical repair is strongly recommended.

Standard Surgery

Standard, open-incision aortic aneurysm repair is a major surgical procedure and performed under general anesthesia. The surgery requires a long incision, from the bottom of the breastbone to the pubic area.

After locating the aneurysm, the surgeon clamps the aorta to shut off the blood flow and repairs the aneurysm. The aorta is repaired by inserting a synthetic graft to replace the part of the artery that has been removed.

The post-operative period is often fairly difficult and generally requires a stay in the hospital for at least a week. Complete recovery often takes three to six months. Depending on your other medical conditions, and the specific location of your aneurysm, serious complications that involve the kidneys, intestines, legs, heart, and lungs are possible.

Endograft Repair

An endograft repair is another method of aortic aneurysm repair. An endograft is a fabric-covered stent that is inserted by a special catheter (tube). It is normally inserted through the femoral artery, a large blood vessel in the groin area. The endograft is then advanced to the site of the aneurysm and deployed to provide a new route for blood flow. 

With this procedure, the aortic aneurysm is not surgically cut out. It is isolated from the blood flowing within the aorta. Because the aneurysm is no longer exposed to blood flow, rupture is theoretically no longer a risk.

In general, endograft repair is recommended for most people with aortic aneurysms. However, depending on your medical condition, an endograft repair may or may not be the right choice for you.

The complications of standard surgery tend to occur very early after the operation, while complications with endograft repair tend to occur later. The complications of endograft repair may include:

• Endoleak: The flow of blood into the aortic aneurysm itself is not completely cut off by the endograft, so the aortic aneurysm can continue to expand—and can even rupture.
• Device migration: This is a complication in which the endograft shifts its position within the aorta at some point in time after the surgical procedure. Device migration, which has been seen in more than 10 percent of patients after endograft repair in some studies, can cause serious problems, including rupture of the aortic aneurysm unless it is treated.

Emergency Treatment for Ruptured Aortic Aneurysm

If you have a ruptured aortic aneurysm, you will need to call 911 for emergency care. You cannot take any time to wait it out or consider whether to call for help. Every second of delay increases the chances of death.

Right after a ruptured aortic aneurysm, the medical and surgical care is focused on controlling life-threatening problems, as well as repair of the aortic aneurysm. If you or a loved one experience an aortic aneurysm rupture, you are likely to need:

• Emergency aortic aneurysm repair
• Stabilization of heart function
• Management of blood loss
• Management of fluid loss/dehydration
• Management of kidney function
• Urgent treatment of end-organ damage, which is damage to any of your organs that can result from the blood loss and shock of an aortic aneurysm rupture