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Abdominal Aortic Aneurysm, Thoracic Aortic Aneurysm Repair- MGH

Aortic Aneurysm

The aorta is the largest artery and main blood vessel of the body. It carries blood from the heart throughout the body. It passes through the chest and abdomen giving off branches to the head, arms and internal organs.

An aortic aneurysm is a dilation, bulging or ballooning of a weakened part of the aortic artery wall. An aneurysm is most often the result of degeneration and weakening of the wall of the aorta. The normal pressure of blood from the pumping of the heart causes the weakened portion of the aorta to slowly stretch and bulge, leading to the formation of an aneurysm.

In addition to atherosclerosis, the risk of an aortic aneurysm can be increased by factors such as high blood pressure and smoking. In rare cases an aortic aneurysm can be caused by an infection or inflammation of the area. Age (over 55) and male gender are also risk factors of the disease. Aortic aneurysms can also be caused by inherited diseases such as Marfan Syndrome. The children of people with aortic aneurysms are at increased risk for aneurysm formation.

Aneurysms can grow progressively larger over time. The principle danger of an aneurysm lies in its potential to rupture, causing an internal hemorrhage. The risk of rupture is related to the size of the aneurysm; additionally, larger aneurysms tend to grow more quickly. Aortic aneurysms that have expanded beyond a certain size may require surgical treatment. Although treatment of aortic aneurysm before it ruptures is usually successful, a ruptured aneurysm is almost always fatal.

Types

There are two types of aortic aneurysms, abdominal and thoracic aortic aneurysms, classified according to their location along the aorta. Aneurysms form most frequently in the abdominal aorta. Less commonly, aneurysms form in the thoracic aorta, within the chest.

How is an Aortic Aneurysm Treated?

Treatment for an aneurysm varies according to its severity and stage. If a rupture is not imminent, the physician may decide to monitor the growth of the aneurysm using ultrasound and CT scans, and attempt to lower the pressure on the aneurysm using medication to lower the blood pressure. New drugs that may retard the growth of aneurysms are being evaluated in research studies.

If the aneurysm has expanded to the stage where a rupture may be imminent, surgical aortic aneurysm repair may be necessary. Alternatively, repair of the aneurysm may be possible using a newer minimally invasive procedure called endovascular stent graft aortic aneurysm repair.

Abdominal Aortic Aneurysm Repair

Open surgery for aortic aneurysm repair is a very well investigated procedure that is considered to carry a low risk of complications and to have a very good success rate. Its aim is to replace or fortify the damaged portion of the vessel (aorta).

General anaesthesia is required for the procedure. An incision is made in the abdomen, and blood flow to the aortic artery is reduced (often by clamping the aorta) in order to facilitate the surgical procedure. The aneurysm is opened, and the blood vessel is replaced with a woven graft (tube) made of synthetic (man made) material, such as Dacron. This graft will bypass the weakened walls of an aneurysm, allowing normal bloodflow to the legs and other organs. Once the graft is in place, blood flow is allowed to resume through the artificial or reinforced artery, and the incision on the abdomen is closed with sutures or surgical staples. The procedure takes approximately 4 hours. In-hospital recovery from the surgery takes approximately five to seven days.

In many cases, endovascular stent graft aortic aneurysm repair, a minimally invasive procedure, is possible as an alternative to open surgery.

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