You might have heard about aneurysm, but are you really familiar with what it is? Let’s know about different types of aneurysm.
An Overview of Aneurysm
An aneurysm is a condition where a blood vessel develops a weakened area, causing it to bulge and expand beyond its normal diameter. This abnormal widening is typically observed in arteries rather than veins, although it can occur in any blood vessel.
An aneurysm can occur in various parts of the body, including the cerebral blood vessels (known as a cerebral aneurysm), aorta (the largest artery in the body), intestines, neck, spleen, kidneys, and vessels in the legs (such as femoral, iliac, and popliteal aneurysms).
Among these locations, the aorta is the most commonly affected blood vessel. The aorta consists of two sections: the thoracic aorta, which is a short segment found within the chest cavity, and the abdominal aorta, which passes through the abdomen.
An aneurysm can be identified based on its shape, location, and underlying cause.
A true aneurysm can be characterised by its shape, which can either be saccular or fusiform. A fusiform-shaped aneurysm is more prevalent and causes the blood vessel to bulge or balloon out in all directions.
On the other hand, a saccular-shaped aneurysm only bulges or balloons out on one side of the blood vessel. These distinct shapes help in the identification and classification of aneurysms.
A false aneurysm, also known as a pseudoaneurysm, is different from a true aneurysm as it does not involve an enlargement of the blood vessel wall layers. Instead, a pseudoaneurysm typically develops as a result of trauma or previous surgery.
As an aneurysm grows, the artery wall weakens, increasing the need for surgical intervention (aneurysm surgery). One of the primary objectives of aneurysm repair is to prevent the rupture of an aneurysm.
For detailed information on various types of aneurysms and the methods used for aneurysm repair, you can conduct an online search using keywords such as ‘aneurysm surgery’, ‘aneurysm repair’, or ‘aneurysm operation’. This will allow you to get in-depth information on these topics.
Symptoms of Aneurysm
The symptoms of an aneurysm can differ depending on its type and location. It is crucial to note that aneurysms in the body or brain often do not exhibit any signs or symptoms until they rupture.
When an aneurysm ruptures, the symptoms can vary depending on where it is located. Aneurysms near the body’s surface may manifest as pain, swelling, or the development of a noticeable mass. The specific symptoms of a ruptured aneurysm depend on its particular location.
Cerebral aneurysm: When a brain aneurysm ruptures, it typically initiates a sudden and severe headache. Additional symptoms can include sensitivity to light, vision disturbances (double vision), loss of consciousness, and feelings of vomiting and nausea.
Aortic aneurysm: The symptoms of an aortic aneurysm differ depending on whether it occurs in the abdomen or chest.
- If a thoracic aortic aneurysm ruptures, the symptoms can include a sudden onset of back pain, intense chest pain, numbness in the limbs, and a significant drop in blood pressure.
- In the case of an abdominal aortic aneurysm rupture, the following symptoms may be experienced: a rapid heart rate, severe and sudden pain in the lower back or abdomen, shortness of breath, feelings of light-headedness or dizziness, and cold sweats.
Aneurysm Surgery
Aneurysm surgery is a procedure used to treat aortic aneurysms. Aortic aneurysms pose serious risks and can lead to life-threatening complications. The primary objective of open surgery is to prevent the rupture or dissection of an aneurysm as well as to repair any damage that may have occurred as a result.
The surgical approach involves removal of the damaged portion of the aorta and its replacement with a synthetic fabric tube called a graft. This graft serves as a new lining for the artery, facilitating safe blood flow through the affected area.
Performed by a thoracic or vascular surgeon in a hospital, aneurysm surgery is a major procedure. It requires a significant incision in either the abdomen or chest, depending on the location of the aneurysm. Whether the aneurysm is in the thoracic (chest) or abdominal area determines the approach.
Aneurysm surgery is typically necessary to prevent severe complications or potential loss of life. While the procedure carries inherent risks associated with major surgeries, the benefits often outweigh these risks. Your healthcare provider will discuss available options with you and determine the most suitable course of action, including the need for surgery.
Aneurysm repair procedures for different types of aneurysms
• Abdominal Aortic Aneurysm (AAA)
An abdominal aortic aneurysm (AAA) is a serious condition with a potential to be life threatening. It involves a bulging in the primary artery responsible for supplying blood to the pelvis, abdomen, and legs. The aneurysm represents a weakened area in the wall of the blood vessel, which puts it at a risk of rupturing and leading to severe bleeding known as a haemorrhage. Occasionally, people refer to an AAA as a stomach aneurysm.
• Aneurysm repair for Abdominal Aortic Aneurysm
Surgical intervention is typically required for aneurysms larger than 5 cm in diameter or those displaying the signs of rupture. The decision for surgery depends on factors such as the location, size, and complexity of the aneurysm. Your healthcare provider will assess these factors and make recommendations accordingly.
Open surgery: During the surgical procedure, the surgeon creates an incision in the abdominal area to reach the abdominal aorta. They then attach a graft, which is a durable and synthetic tube, to the weakened portion of the aorta. This graft reinforces the aneurysm, reducing the risk of rupture. Following the open surgery, patients typically remain in the hospital for a period ranging from 4 to 10 days. The recovery process can take several months.
Endovascular aneurysm repair (EVAR): EVAR is a minimally invasive surgical procedure used to treat aneurysms. It involves a small incision made in the groin area, through which a catheter (flexible and thin tube) is inserted into an artery. Using an X-ray, the catheter is carefully navigated to the site of the aneurysm. Inside the catheter, there is an expandable stent that is deployed within the aorta to reinforce the weakened area and prevent rupture. Following EVAR, the hospital stay typically lasts for around 3 days, and the recovery period is shorter compared to open surgery.
After undergoing either type of aneurysm repair, it is essential to maintain regular follow-up appointments with your healthcare provider to monitor the condition of your repaired aorta. This ongoing surveillance can be conducted using ultrasound or CT scans to assess the integrity and function of the repaired area. Keeping up with these follow-up appointments is crucial for long-term monitoring and ensuring the continued health of your aorta.
• Thoracic Aortic Aneurysm
It refers to an enlargement or bulge in the section of the aorta that passes through the chest.
This condition occurs when the wall of the aorta weakens due to factors such as connective tissue disorders, plaque build-up, or other underlying causes.
It is common for individuals with a thoracic aortic aneurysm to remain asymptomatic until the aneurysm becomes a medical emergency. It is important to consult with a healthcare provider who can assess your risk factors and provide guidance on maintaining your health and well-being.
• Aneurysm repair for Thoracic Aortic Aneurysm
Surgery on the aorta is the primary and most effective method for treating thoracic aortic aneurysms. Healthcare providers employ various surgical techniques, which include:
Traditional open surgery – This conventional approach to aneurysm repair entails making a cut along the centre of the chest. The surgeon removes the damaged region of the aorta and substitutes it with a synthetic fabric tube known as a graft. This method is utilised for aneurysms located in the ascending aorta as well as complex aneurysms in the chest and abdominal regions.
Thoracic endovascular aortic repair (TEVAR) – This less invasive treatment option is used for aneurysms located in the descending aorta. It involves making small incisions near the groin area to access the femoral artery. A catheter is then utilized to guide the graft to the aneurysm site and position it accordingly.
Aortic root replacement – This surgical procedure is employed for aneurysms occurring in the aortic root, which is the section of the aorta connecting to the heart. In some cases, the surgeon may replace the aortic valve alongside the aneurysm repair. Alternatively, valve-sparing techniques may be utilized to preserve the natural valve whenever possible.
Depending on the specific characteristics of the aneurysm, surgeons may opt to combine different surgical approaches, such as a combination of endovascular methods and open surgery. It is advisable to seek treatment at a specialized aorta centre that focuses on the management of aortic diseases. By doing so, you can benefit from a broader range of treatment options and enhance your overall prognosis and outcome.
• Cerebral aneurysm
A cerebral (brain) aneurysm refers to an abnormal bulge in a weakened region of a blood vessel located in or around the brain. The majority of aneurysms are small and typically do not cause any problems. However, a ruptured brain aneurysm can be extremely dangerous and potentially life-threatening. The primary indication of a ruptured brain aneurysm commonly manifests as a severe headache.
• Microvascular clipping for brain aneurysms
In this surgical procedure, a neurosurgeon creates a small incision in the skull to reach the aneurysm. Utilizing a small microscope and precise instruments, the neurosurgeon carefully places a metal clip at the surface of the aneurysm to compress and close it off. This action prevents the blood circulation inside the aneurysm. The purpose of the surgery is to halt a brain haemorrhage or prevent the expansion and rupture of an intact aneurysm.
• Endovascular coiling for brain aneurysm
In this procedure, either an interventional neuroradiologist or neurosurgeon introduces a catheter into a blood vessel, typically in the wrist or groin, and directs it to the brain. Using the catheter, a small coil made of soft wire is carefully placed inside the aneurysm. Once released, the coil alters the blood flow pattern within the aneurysm, leading to the formation of a clot. This clot effectively blocks the entry of blood inside the aneurysm, providing a seal similar to that achieved with a clip.
• Flow diversion stents
During this procedure, an interventional neuroradiologist or neurosurgeon introduces a catheter into a blood vessel located in either the wrist or groin and navigates it to the brain. Via the catheter, the medical professional positions a mesh tube within the section of the blood vessel where the aneurysm is present. The purpose of the mesh is to redirect or promote blood flow elsewhere from the aneurysm instead of into it.
Preparation required for Aneurysm Surgery
Preparation for your surgery begins several weeks before the procedure. Your healthcare provider will conduct a physical examination and perform necessary tests to ensure the safety of the surgery. During this time, you will have a discussion with your provider regarding various aspects, including:
Medications you are currently taking – It is important to inform your provider about all the medications, supplements, and herbal products you are using, including both prescription and over-the-counter drugs. Your provider may advise you to discontinue certain medications before the surgery. It is crucial to carefully follow your provider’s instructions regarding which medications to continue or stop.
Management of medical conditions – It is essential to effectively manage any existing medical conditions, such as high blood pressure, before the surgery.
Overall health status – If you are experiencing any illness or health issues, such as a cold, flu, or herpes outbreak, it is important to inform your provider. Your current health condition may affect your response to the surgery.
Smoking habits – It is advised to refrain from smoking for at least one month leading up to your surgery. Your provider can provide resources and support to help you quit smoking.
Risks and complications of Aneurysm operation
Aneurysm surgery is a potentially life-saving procedure, but it is crucial to be aware of the potential complications and risks involved. These may include bleeding, formation of blood clots, damage to organs such as the intestines, graft-related infections, respiratory issues, stroke or heart attack, kidney failure, infections in the urinary tract, lungs, or abdomen, spinal cord injury, and nerve damage.
It is important to have a detailed discussion with your healthcare provider about the specific risks that may be more relevant to your health condition. Risks and complications can vary depending on the individual. It is essential to acknowledge that surgery always carries some degree of risk. However, your healthcare team will take all necessary precautions and measures to ensure the safety and success of your surgery.
