WHAT IS AN ANEURYSM AND WHY IS IT IMPORTANT?
The word "aneurysm' means out-pouching or bulging of a portion of a blood vessel that can occur anywhere in the body. When an aneurysm occurs in the aorta, the largest blood vessel in the body, it is either a thoracic aneurysm, located the chest, or an abdominal aneurysm. The elastic fibre in the vessel wall can undergo damage and become weak. This causes the wall to bulge resulting in an aneurysm. The size continues to increase because of the blood pressure and when it reaches a critical size ruptures just like blowing too much air into a balloon. This can be a life-threatening emergency. The goal of surgery is to intervene before that happens by removing the dilated portion of the vessel and replacing it with a graft a tube of synthetic material, that won't rupture or tear.
WHAT CAUSES AN AORTIC ANEURYSM?
- Atherosclerosis (Cholesterol deposition in the wall of the arteries)
- Chronic or untreated high blood pressure
- Smoking
- Injury (for example, a car accident)
- Infection results in weakening of wall
- Inherited conditions (for example, Marfan syndrome,These are all conditions that have thepotential to weaken the wall of the vessel, allowing it to dilate or balloon out over time.
WHAT ARE THE SYMPTOMS OF AN AORTIC
Aortic Aneurysms usually do not cause symptoms until they get quite large. They often are found during an examination for a different medical condition. When they are large enough to cause symptoms, people may notice pulsating mass in the abdomen, chest or abdominal pain, back pain, palpitations, fatigue, dizziness or shortness of breath. Sudden severe abdominal or back pain that feels like the worst pain anyone has ever had is usually a sign of a tear or rupture and is an extreme medical emergency
HOW ARE AORTIC ANEURYSMS DISCOVERED OR DIAGNOSED?
Large aneurysms can be seen on a chest or abdominal x-ray. They are also detected by studies such as routine ultra sound abdomen, CT scan, MRI, or echocardiography. These studies also help to determine the exact location and size of the aneurysm. When a small aneurysm is found, the study used to find it is repeated on a regular basis, usually every six to 12 months, to monitor any change in size. This helps determine the ideal time for surgical intervention
INTERVENTION IS USUALLY ADVISED IF THE ANEURYSM IS
- Larger than 5.5cm
- Growing by more than 1cm per year
- Causing pain
Open Surgery for aneurysms
Surgical repair involves removal of the diseased portion of the aorta. Clamps are placed above and below the aneurysm, which is then cut out and removed. A fabric tube, or graft, is sewn onto both cut ends to replace the diseased portion that is removed. The most common site for aortic aneurysm is in the abdomen involving the aorta below the renal arteries. A inverted Y shaped graft is sutured to the aorta after removing the diseased aorta. This is a major operation, needing stay in the ICU for 2-3 days and in the hospital for nearly one week or more. Patients generally take a month to resume their normal activities. Hence minimally invasive stent procedures have become popular
But once the patient recovers from surgery there is no need for frequent screening and check ups as is the case with endovascular repair.
