What's the treatment for aortic aneurysms?
Medical therapy of aortic aneurysms involves strict blood pressure control. This does not treat the aortic aneurysm per se, but tight blood pressure control with prevention of hypertension may decrease the rate of expansion of the aneurysm. The definitive treatment for an aortic aneurysm is surgical repair of the aorta. This typically involves opening up of the dilated
portion of the aorta and insertion of a dacron patch tube. Once the tube is sewn into the proximal and distal portions of the aorta, the aneurysmal sac is closed around the artificial tube.
A recent treatment option is the placement of a stent via a percutaneous technique into the diseased portion of the aorta. Percutaneous stenting of aortic aneurysms has a lower mortality rate than an open surgical approach, and has been used in individuals with co-morbid conditions that make them a high risk for surgery.
The determination of when surgery should be performed is usually based on the diameter of the aneurysm. A rapidly expanding aneurysm should be operated on as soon as feasible, since it has a greater chance of rupture. Slowly expanding aortic aneurysms may be followed by routine diagnostic testing (ie: CT scan or ultrasound imaging). If the aortic aneurysm grows at a rate of more than 1 cm/year, surgical treatment should be electively performed.
The current treatment guidelines suggest elective surgical repair of an abdominal aortic aneurysm when the diameter of the aneurysm is greater than 5cm. However, recent data suggests medical management for abdominal aneurysms with a diameter of less than 5.5 cm.
In the case of thoracic aortic aneurysms, the current recommendation for treatment of an ascending aortic aneurysm is elective repair when the diameter is greater than 5.5 cm if the individual does not suffer from Marfan's syndrome. If the aneurysm is below the arch of the aorta, the treatment of a descending thoracic aortic aneurysm is elective repair when the diameter is greater than 6.5 cm. In individuals with Marfan's syndrome, surgical treatment of an ascending aneurysm should be performed when the diameter of the aorta reaches 5cm, while treatment of a descending thoracic aneurysm should be performed when the diameter of the aorta reaches 6 cm.
If the aneurysm is small and there are no symptoms (for example, if the aneurysm is found during a routine physical examination), your health care provider may recommend periodic evaluation, usually with annual ultrasound examination, to watch for changes.
Symptomatic aneurysms usually require surgical treatment to prevent complications. Antihypertensive medications may be prescribed before surgery to reduce blood pressure. Other medications may include analgesics to relieve pain.
Surgical repair or replacement of the section of aorta is recommended for patients with symptoms, as they are at high risk of fatal rupture. Repair is also recommended for patients with aneurysms greater than 5 cm in diameter. Stenting is also a treatment option. The goal of treatment is to perform surgery before complications develop.
Stenting involves the use of a tube placed inside the vessel and can be performed without an abdominal incision, with specialized catheters that are introduced through arteries at the groin. Not all patients with abdominal aortic aneurysms are candidates for stenting, however.
The risk of complications increases as the size of the aneurysm increases. Because surgery for abdominal aortic aneurysm is risky, the surgeon may wait for the aneurysm to expand to a certain size before operating (that is, when the risk of complications exceeds the risk of surgery).