What is the treatment for an aortic aneurysm?

Aortic aneurysms are treated with medicines and surgery. A small aneurysm that's found early and isn't causing symptoms may not need treatment. Other aneurysms need to be treated.

Treatment for aortic aneurysms is based on the size of the aneurysm. Your doctor may recommend routine testing to make sure an aneurysm isn't getting bigger. This method usually is used for aneurysms that are smaller than 5 centimeters (about 2 inches) across.

How often you need testing (for example, every few months or every year) will be based on the size of the aneurysm and how fast it's growing. The larger it is and the faster it's growing, the more often you may need to be checked.

If you have an aortic aneurysm, your doctor may prescribe medicines before surgery or instead of surgery. Medicines are used to lower blood pressure, relax blood vessels, and reduce the risk of rupture. Beta blockers and calcium channel blockers are the medicines most commonly used.

Your doctor may recommend surgery if your aneurysm is growing quickly or if it reaches a size linked with an increased risk of rupture or dissection.

The two main types of surgery to repair aortic aneurysms are open abdominal or pen chest repair and endovascular repair.

Open abdominal or open chest repair
The standard and most common type of surgery for aortic aneurysms is open abdominal or open chest repair. It involves a major incision (cut) in the abdomen or chest. General anesthesia is used for this procedure—that is, you will be temporarily put to sleep so you don't feel pain during the surgery.

The aneurysm is removed, and the section of aorta is replaced with a graft made of material such as Dacron® or Teflon® the surgery takes 3 to 6 hours, and you will remain in the hospital for 5 to 8 days.

It often takes a month to recover from open abdominal or open chest surgery and return to full activity. Most patients make a full recovery.

Endovascular repair
In endovascular repair, the aneurysm is not removed. Instead, a graft is inserted into the aorta to strengthen it. This type of surgery is done using catheters (tubes) inserted into the arteries; it doesn't require surgically opening the chest or abdomen.

This answer from the National Heart, Lung and Blood Institute has been reviewed and/or edited by Dr. William D. Knopf.

An aneurysm is an enlargement of a blood vessel. Most commonly, aneurysms involve the aorta, which is the large blood vessel that brings blood from the heart to the body. Smaller aneurysms are often treated with blood pressure management and monitored with CT scans at 6- to 12-month intervals. Larger aneurysms are at risk for tearing or rupturing like a water balloon. If your aneurysm reaches a larger size, surgery may be recommended to replace that section of the aorta with a tube graft. In recent years however, surgeons have begun using stent grafts to cover aneurysms from the inside, which is less invasive. Stent grafts are tubes inserted through blood vessels in the legs. Not everyone meets the anatomic requirements that are necessary to use a stent graft. Your surgeon can let you know if you are candidate for a less invasive approach.

Dr. William J. Quinones Baldrich, MD
Vascular Surgeon

Management of patients with aortic aneurysms in all instances involves control of risk factors. Cigarette smoking is not only associated with the formation of aneurysms but also increases the risk of rupture. Cessation of cigarette smoking is essential in patients with conservative management of aortic aneurysms. Control of blood pressure is also important as uncontrolled hypertension is associated with an increased risk of rupture. Cholesterol medication or statins have been associated with improved outcomes in a patient's aortic aneurysms. The use of beta blockers, which slows down the heart rate, has been suggested to decrease the rate of growth of aortic aneurysms. The decision between conservative management or repair for patients with aortic aneurysms takes into consideration the risk of rupture, the patient’s risk factor, the risk of repair, and patient’s preference. In modern practice there are essentially two alternatives for repair of aortic aneurysms. Surgical repair involves an incision, exposure of the affected segment of the aorta, and replacement with the prosthetic or artificial graft. In the abdomen, the incision may be in the middle or in the left flank, which avoids exposure of the intestines. An alternative to surgical repair is endovascular repair. This involves the insertion of stent grafts to exclude the aneurysm. The stent grafts are usually inserted through the groin arteries, and in modern practice this can be done percutaneously with minimal incisions. Endovascular repair has been associated with a decrease in mortality and in complications. It leads to faster recovery. When aneurysms involve branches of the aorta, stent graft technology can now be applied using fenestrated or branched grafts. A third alternative is to combine in the endovascular technology with standard open surgical techniques.

Aortic aneurysms are one of the most complicated and potentially dangerous vascular conditions. Our physicians are utilizing one of the newest available treatments, endovascular stents. A stent is placed over the aneurysm, reducing the risk it will suddenly rupture and bleed. Radiologists and surgeons are using a unique team approach to perform the procedure, insuring the highest level of patient safety. For many patients, this new, less invasive treatment approach reduces the need for delicate and complicated bypass surgery.

Aortic aneurysms can be repaired with surgery or with stents.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.