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Medical Author:

Shabir Bhimji, MD

Coauthor:

Bryan Hoynak, MD

Medical Editor:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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Although a ruptured aortic aneurysm can be repaired by surgery, these cases tend to be less successful than in those individuals who undergo surgery for unruptured aneurysms. Generally only about 50% of people who undergo urgent surgery for repair of a ruptured aneurysm survive. Even in those who survive surgery, kidney failure, dead bowel, and leg ischemia are common complications. However, even asymptomatic patients with inflammatory AAA or AAA that have had symptoms of emboli, pain, or bowel obstruction require emergent repair regardless of aneurysm size.

Open surgery has long been the accepted treatment for aortic aneurysms of the chest or abdomen.

• A large incision is made in the chest or the abdomen.
• Blood flow in the aorta is stopped by hooking the circulatory system to an outside pump (heart and lung machine). This machine circulates blood to the body and keeps the vital organs and other tissues oxygenated properly.
• The damaged section of the aorta is removed and replaced by an artificial blood vessel (graft) made of cloth fabric. The graft is sewn in place.
• Although this surgery is usually successful, it has its own risks to the heart, brain, lungs, and kidneys. It also involves considerable recovery time because of the size of the incision and complexity of the surgery. Usually a patient has to stay in the hospital for a week, and recovery time is at least 6 weeks.

Abdominal aortic aneurysm (AAA)

Treatment for these aneurysms has recently focused on procedures that are less invasive than conventional surgery.

• One widely used alternative is stenting of the aneurysm by a vascular surgeon or an interventional radiologist.
• A stent is a tiny metal and fabric device like a miniature scaffold. It is threaded through the blood vessel from a small incision, usually in the groin. A thin plastic tube called a catheter is used to thread the stent through the blood vessel.
• The stent is fastened to the inner vessel wall just above the level of weakened aortic wall to help support the blood vessel. This reduces strain on an existing aneurysm and can prevent a full-blown aneurysm from developing again.
• Stenting is not only much faster than conventional surgery; it offers much shorter recovery time and fewer complications. In 2006, stenting surpassed open surgical techniques in terms of numbers of aortic repairs. However, stent complications include endovascular leaks that may require a secondary procedure. The long term outcome of stenting is still under study. The appropriate choice of procedure, open versus stenting, depends on many factors and is best determined by for each individual by their primary care professional and vascular surgery team.

Picture of a stent in an abdominal aortic aneurysm.

Thoracic aortic aneurysm

• Surgical repair of these aneurysms often requires full cardiopulmonary bypass by a thoracic surgeon.
• Stenting of thoracic aortic aneurysms has been shown to be possible, but it is most often done only on the descending thoracic aorta.

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