What`s an aneurysm? Q and A
We started endovascular aneurysm repair of abdominal and thoracic aorta.
This article explains what aortic aneurysm is.
The aorta is the main artery in the body. It runs from the heart, through the chest and abdomen and supplies branches to all the major organs. An aortic aneurysm is a general term for an enlargement (dilation) of the aorta to greater than 1.5 times normal size (normal size of a thoracic aorta and an abdominal aorta are 3cm and 2cm respectively).
This is a result of weakening of the artery wall, which then stretches due to the pressure of the blood flowing through the aorta, to form an aneurysm. The larger the aneurysm is, the greater the chance that it might rupture (burst) and if an aneurysm ruptures it can be fatal.
Medical therapy of aortic aneurysm involved strict blood pressure control. This does not treat the aortic aneurysm per se, but control hypertension within tight blood pressure parameters may decrease the rate of expansion of the aneurism. Once an aorta enlarges, no medical therapy can reduce its size. Only surgical therapy can prevent further enlargement of aorta.
Decisions on if and when to repair an aortic aneurysm are based on the balance between the risk of aneurysm rupture without treatment versus the risks of the treatment itself. There are two approaches for surgical repair; Open surgery and endovascular repair.
The abdominal (thoracic) aorta reaches 3cm (4cm) in diameter, it is classified as an aneurysm.
Surgical repair should proceed when the abdominal (thoracic) aorta reaches a diameter 4cm (5cm). It is also indication of surgical repair that the rate of enlargement of aorta is more than 0.5mm per half year.
Strict blood pressure control
Normalizing your lifestyle habit (smoking, exercise etc)
Please follow instruction of your home physician or cardiologist.
2.Aortic replacement (open surgery)
Surgery for aortic aneurysms involves opening the chest or the abdomen and replacing the aorta and inserting a synthetic aorta. The procedure has risks, generally, mortality for abdominal aneurysm is approximate 1%, for thoracic aneurysm is 5-10%.
When rupture occurs, massive internal hemorrhage results, can be fetal. Even if emergency surgery can undergo, the mortality is very high.
3. Endovascular aneurysm repair
A small surgical incision near the groin is put, to find femoral artery, and a surgeon insert a stent and a synthetic graft through the cut into the artery. Then open the stent to cover your aneurysm. Eventually, the endograft, once in place, acts as an artificial lumen for blood to flow through, and not into the surrounding aneurysm sac.
Some situations are contra-indications.
• There are important branches near aneurysm.
• A tortuous aorta.
However, newly developed techniques could be solution of above cases. One is a specially designed graft, another is hybrid procedure (the prior placement of surgical bypass graft to important branch allows to deployment of the endograft at the level that would otherwise not be possible).
Because endovascular aneurysm repair have a short history, the long term result is unknown. Especially an endoleak, which is a leak into the aneurysm sac after endovascular repair, is one of big problems of the procedure.
For the above reasons, we should discuss before select the procure to repair the aneurysm.
We have a clinic on Tuesday and Thursday. You can get appointment on the phone. Please don’t hesitate to consult us even before you decide to undergo the procedure at our Hospital.
Q and A
Q1. Medication can reduce aneurysm size?
A1. Unfortunately, there is no medicine that can reduce aneurysm size at the moment. Strict blood pressure control might prevent enlarge aneurysm size more. Only surgical repair can remove the risk of aneurysm rupture.
Q2. I have an aneurysm. How much blood pressure should I control?
A2. You must control your blood pressure strictly. Please keep systolic (higher) blood pressure less than 130mmHg.
Q3. I have an aneurysm. Can I exercise?
A3. If your home physician told you that your aneurysm size didn’t reach the size it is recommended repair, you can do light exercise except for extreme one. However the doctor recommend surgical repair, you can just walk slowly.
During exercise, if you feel pain or high blood pressure, please stop exercise and consult your physician.
Q4. My home doctor told me `If you don’t undergo surgery to repair aneurysm, the risk of aneurysm rupture is very high.’ But I don’t feel any symptom at all. Is that true?
A4. The final decision is yours. Please understand both risks of rupture and surgery. And then please talk to your doctor again and decide.
Q5. My home doctor told me I have thoracic aortic aneurysm near neck vessels and the risk is too high to do operation due to comorbidity. How about endovascular repair?
A5. We need check your aneurysm on CT angiography before give our advice. If CT angiography indicates the risk of rupture is high, we consider surgical repair. We will decide whether open surgery or endovascular repair is suitable for you after we evaluate your aneurysm type, size and place and your condition.