Sarasota Cardiac & Thoracic Surgery

Aneurysm Surgery PDF - Click Here to Print

An aortic aneurysm is a stretched and bulging section in the wall of the aorta. The aorta is the large blood vessel that carries oxygen-rich blood from the heart to the rest of the body. A bulging aorta is weakened and can burst, or rupture, resulting in life-threatening bleeding. Ruptured aortic aneurysm is the 15th leading cause of death in the United States. Each year approximately 15,000 Americans die of a ruptured aortic aneurysm. When detected in time an aortic aneurysm can usually be repaired with surgery. Repair consists of excising the dilated portion of the vessel and replacing it with a synthetic, tube shaped graft.

Types

The two types of aortic aneurysms are abdominal aortic aneurysm and thoracic aortic aneurysm. This classification is based on where the aneurysm occurs along the aorta. The thoracic section of the aorta travels through the chest and supplies oxygen-rich blood to the upper body. The abdominal section of the aorta continues through the abdomen and supplies oxygen-rich blood to the lower body. Seventy-five percent (75%) of aneurysms occur here.

Shapes

Aneurysms occur in different shapes as well- fusiform or true aneurysms and saccular or (false) pseudoaneurysms. In fusiform aneurysms the weakness is often along an extended section of the aorta and involves the entire circumference of the aorta. The weakened portion appears as a generally symmetrical bulge, as opposed to a saccular aneurysm which appears like a small blister or bleb on the side of the aorta and is asymmetrical.

Dissecting aneurysms

These occur when a tear begins within the wall of the aorta. The dissection (of the three layers of the aorta) causes the wall of the aorta to weaken, and the aorta enlarges. Dissections may occur any place along the aorta and treatment depends upon the location. Frequently, those involving the ascending (first few inches above where the aorta leaves the heart) portion of the aorta are treated with emergency surgery while those involving the descending thoracic (just past the branches which feed the head and arms) aorta are treated with medication. Although dissections are uncommon, they are the most common of the acute aortic syndromes. They are lethal if left untreated.

Causes

• Arteriosclerosis or hardening of the arteries weakens arterial walls
• Hypertension (high blood pressure)
• Local injury to the artery
• Congenital abnormality. A number of conditions, such as Marfan's syndrome, are present at birth and can cause weakness of the artery walls.
• Aging
• Syphilis used to be a common cause of thoracic aneurysms, but is no longer common.
• Smoking
• Family History

Symptoms

Most aortic aneurysms have no symptoms. In fact, most are diagnosed on a chest X-ray or computerized tomography (CT) scan performed for evaluation of another condition, such as lung disease, or during routine exams. Severe chest or back pain will occur in only 30% of cases. Thoracic aneurysms may cause shortness of breath, hoarseness, brassy cough, and difficulty swallowing (due to pressure on other organs). Rupture of an aneurysm can cause loss of consciousness, stroke, shock or a heart attack. If you experience any severe, unexplained chest or back pain you should seek medical attention immediately.

Treatment

The size and location of an aneurysm will mandate the approach to treatment. Generally, aneurysms that are less than 5 cm in size are significantly less likely to rupture than those greater than 6 cm. So, smaller ones are monitored with serial CT scans to see if they are increasing in size. Larger aneurysms or those that are increasing in size should be considered for surgical repair.

Our surgeon has advanced training in the treatment of aneurysms. The operation, including the incision that is made, depends on the location of the aneurysm. If the aneurysm is close to the aortic valve, an incision in the front of the chest such as a median sternotomy may be used. If the aneurysm is close to the valve, the aortic valve may have to be repaired or replaced. Surgery on the aortic arch is usually done from the front as well. If the aneurysm involves the descending thoracic aorta, which lies in the left chest, or the thoracic abdominal aorta, an incision on the left side of the chest will likely be required. If the aneurysm is confined to the abdomen, then an incision either in the abdomen, or on the side or flank may be used.

In recent years, a treatment has been developed to repair an aneurysm without major surgery. Many surgeons have been using less invasive endovascular surgery for abdominal aortic aneurysms and thoracic aneurysms. The procedure results in less blood loss and less trauma to the aorta. Endovascular surgery may benefit those who need surgery but are at high risk of complications because of pre-existing medical problems. However, not every person is a good candidate for this procedure. The appropriate choice of procedure, open versus endovascular, depends on many factors and is best determined by the surgeon in consultation with the patient.

Procedures Performed

• Acute Type A and Type B aortic dissection
• Ascending aortic and aortic arch aneurysm
• Aortic root reconstruction
• Thoracoabdominal aortic aneurysms
• Thoracic endografting

Aortic Disease Management Program

Our practice provides long-term care for patients diagnosed with aneurysms. This includes patients who are not ready for surgery or who have already had surgery. We see all emergency cases including ruptured aneurysms, dissections, and traumatic transections. Our surgeons also consult on second-opinion cases and perform re-operative procedures routinely.