Treatment for an aortic aneurysm will depend on several factors. These include the aneurysm’s size and whether it has ruptured.
Small and unruptured aortic aneurysms that are not causing symptoms may be monitored for changes. At the guidance of your medical provider, you will have an ultrasound or CT scan at regular intervals.
These imaging tests help the provider to know whether the aneurysm is growing or is at risk of leaking (aortic dissection) or rupture. Active surveillance is sometimes called “watchful waiting.”
- Aspirin therapy: In some patients, over-the-counter aspirin can thin the blood and reduce the risk for clots that can cause heart attacks or strokes. You should only use daily aspirin therapy if it is recommended by your doctor.
- Blood pressure medicines: Also known as antihypertensives, blood pressure medicines are prescription drugs that help lower high blood pressure. Many types of blood pressure medicines are available. They can reduce blood pressure by:
- Lowering the heart rate
- Reducing blood output
- Removing excess water and sodium from the body
- Relaxing the blood vessels
- Helping blood vessels dilate
- Blood-thinning medicines (anticoagulants): This type of medicine helps prevent blood clots from developing.
- Cholesterol medicines: These medicines help lower cholesterol in your blood by:
- Reducing the liver’s production of cholesterol
- Lowering the amount of cholesterol absorbed from food
- Lowering triglycerides
- Increasing high-density lipoprotein (the “good” cholesterol)
Endovascular aneurysm repair, also known as EVAR, is a minimally invasive treatment for thoracic aortic aneurysm (TAA) and abdominal aortic aneurysm (AAA). Unlike open surgery, which is performed through a large incision, EVAR is performed through small incisions near the top of your groin. EVAR can be performed with regional or general anesthesia.
In complex cases where endovascular aneurysm repair isn’t a good option, your vascular surgeon may opt for an open (or traditional) surgery.
During an open aneurysm repair, you’ll be given general anesthesia to put you to sleep. Your surgeon will then make a long incision in the skin of the chest (for TAAs) or abdomen (for AAAs). Clamps will be used to block blood flow from the portions of the aorta above and below the aneurysm. Once blood flow is blocked, the surgeon will replace the bulging portion of the aorta with a graft made of an artificial material.
The graft, which has fortified walls to support blood flow, is sewn into place. Once the graft is in place, your surgeon will close the incision in the chest or belly with stitches or staples.
An open surgery for treating aortic aneurysm typically takes three to four hours. After the surgery, you will be carefully monitored in the intensive care unit (ICU) for several days. You will then be moved into a regular hospital room. Your recovery time, both in the hospital and after discharge, will depend on the specifics of your surgery. Factors include whether you needed a heart-lung machine during the surgery.
In cases where an aneurysm forms in the aortic root – the part of the aorta that attaches to the heart – an aortic root procedure may be needed. Depending on the extent of the aneurysm, aortic root replacement surgery may replace both the aortic root and the aortic valve or only the aortic root. When the valve doesn’t need to be replaced, the surgery is called a valve-sparing root replacement.
During aortic root replacement, you’ll be put to sleep using anesthesia and placed on a cardiopulmonary bypass machine. This machine performs the job of the heart and lungs. Your surgeon will make a large incision in the chest. The surgeon will then break open the sternum to access the heart.
Your surgeon will remove the aortic aneurysm in the aortic root and replace it with a graft made of an artificial material. If needed, your surgeon will also replace the aortic valve using either a biological or mechanical valve. To finish, your surgeon will reattach the coronary arteries to the graft, rewire the sternum to stabilize it and close the incision with stitches.
After your surgery, we will carefully monitor you in the ICU for several days before you are moved into a regular hospital room. Patients usually spend about a week in the hospital after this surgery. Complete recovery after an open-chest surgery typically takes two to three months.
