An aneurysm is a balloon-like bulge in an artery. Aneurysms can form in arteries of all sizes. An aneurysm occurs when the pressure of blood passing through part of a weakened artery forces the vessel to bulge outward, forming what you might think of as a blister. Not all aneurysms are life threatening. But if the bulging stretches the artery too far, this vessel may burst, causing a person to bleed to death. An aneurysm that bleeds into the brain can lead to stroke or death.
Where do aneurysms occur in the body?
- In the tiny arteries that supply blood to the brain (the cerebral arteries).
- In parts of the large vessel that carries blood from the heart to other parts of the body (the aorta). Aortic aneurysms can occur in the area below the stomach (abdominal aneurysms) or in the chest (thoracic aneurysms). An abdominal aortic aneurysm (AAA) is usually located below the kidneys.
- In the heart's main pumping chamber (the left ventricle).
Why do I need surgery?
There are different operations to treat the different kinds of aneurysms. Here we will talk about the surgery to treat aortic aneurysms, those that occur in the body's main artery.
Surgery to repair an aortic aneurysm depends on the size and location of the aneurysm and your overall health. Aortic aneurysms in the upper chest (the ascending aorta) are usually operated on right away. Aneurysms in the lower chest and the area below your stomach (the descending thoracic and abdominal parts of the aorta) may not be as life threatening. Aneurysms in these locations are watched for varying periods, depending on their size. If they become about 5 centimeters (almost 2 inches) in diameter, continue to grow, or begin to cause symptoms, you may need to have surgery to stop the aneurysm from bursting.
What does the surgery involve?
Surgery involves replacing the weakened section of the vessel with an artificial tube, called a graft. This means that surgeons will have to open either the stomach area (for abdominal aneurysms) or the chest (for thoracic aneurysms).
What to expect
The operation will usually be scheduled at a time that is best for you and your surgeon, except in urgent cases. As the date of your surgery gets closer, be sure to tell your surgeon and cardiologist about any changes in your health. If you have a cold or the flu, this can lead to infections that may affect your recovery. Be aware of fever, chills, coughing, or a runny nose. Tell the doctor if you have any of these symptoms.
Also, remind your cardiologist and surgeon about all of the medicines you are taking, especially any over-the-counter medicines such as aspirin or those that might contain aspirin. You should make a list of the medicines and bring it with you to the hospital.
It is always best to get complete instructions from your cardiologist and surgeon about the procedure, but here are some basics you can expect if you are having aneurysm surgery.
Before the hospital stay
Most patients are admitted to the hospital the day before surgery or, in some cases, on the morning of surgery.
The night before surgery, you will be asked to bathe to reduce the amount of germs on your skin. After you are admitted to the hospital, the area to be operated on will be washed, scrubbed with antiseptic, and, if needed, shaved.
A medicine (anesthetic) will make you sleep during the operation. This is called "anesthesia." Because anesthesia is safest on an empty stomach, you will be asked not to eat or drink after midnight the night before surgery. If you do eat or drink anything after midnight, it is important that you tell your anesthesiologist and surgeon.
If you smoke, you should stop at least 2 weeks before your surgery. Smoking before surgery can lead to problems with blood clotting and breathing.
Day of Surgery
Before surgery, you may have an electrocardiogram (ECG or EKG), blood tests, urine tests, and a chest x-ray to give your surgeon the latest information about your health. You will be given something to help you relax (a mild tranquilizer) before you are taken into the operating room.
Small metal disks called electrodes will be attached to your chest. These electrodes are connected to an electrocardiogram machine, which will monitor your heart's rhythm and electrical activity. You will receive a local anesthetic to numb the area where a plastic tube (called a line) will be inserted in an artery in your wrist. An intravenous (IV) line will be inserted in a vein. The IV line will be used to give you the anesthesia before and during the operation.
After you are completely asleep, a tube will be inserted down your windpipe and connected to a machine called a respirator, which will take over your breathing. Another tube will be inserted through your nose and down your throat, into your stomach. This tube will stop liquid and air from collecting in your stomach, so you will not feel sick and bloated when you wake up. A thin tube called a catheter will be inserted into your bladder to collect any urine produced during the operation.
The cardiovascular surgeon leads the surgical team, which includes other assisting surgeons, an anesthesiologist, and surgical nurses. When the operation begins, the surgeon will make a cut (called an incision) either in the abdomen or the chest. The incision depends on where the aneurysm is located.
Surgeons will then place clamps on the artery above and below the aneurysm to stop blood flow to that part of the aorta. Your heart and brain still get blood because other vessels take over.
The bulging section of the aorta is cut out (excised). The surgeon will then replace the missing piece with a fabric tube called a graft. The clamps are then removed slowly to allow blood to flow through the vessel again.
Sometimes surgeons do not cut out the bulging section of the aorta. In these cases, the operation is the same except that surgeons place the fabric graft inside the vessel, like a lining, to decrease the pressure on the wall of the artery. This procedure is called endoaneurysmorrhaphy.
If the aneurysm is located in the ascending aorta just above the heart, the heart-lung machine will be used.
The surgery takes about 2 to 4 hours.
You can expect to stay in the hospital for 5 to 7 days, including at least 1 to 2 days in the Intensive Care Unit (ICU).
You will be given medicines called diuretics, which help to control any fluid buildup after surgery. You may also need to take aspirin for the first 6 weeks after surgery to stop any blood clots from forming.
Life after aneurysm surgery
After aneurysm surgery, you should limit the fat and cholesterol in your diet. Your doctor may recommend an exercise program. You may also need to make some lifestyle changes, such as starting a new diet, quitting smoking, and learning to deal with stress.
If you have an office job, you can go back to work in about 4 weeks. If you have a more physically demanding job, you may have to wait 6 to 8 weeks, or more.
Non-surgical repair of abdominal aortic aneurysms
Cardiologists at the Texas Heart Institute were among the first to use a nonsurgical technique to treat high-risk patients with abdominal aortic aneurysms. This technique is useful for patients who cannot have surgery because their overall health would make it too dangerous.
The procedure uses a catheter to insert a device called a stent graft. The stent graft is placed within the artery at the site of the aneurysm. The stent graft acts as a barrier between the blood and the diseased wall of the artery. The blood flows through the stent graft, decreasing the pressure on the wall of the weakened artery. This decrease in pressure can prevent the aneurysm from growing or bursting.
Benefits of the procedure include no general anesthesia (you are awake for the procedure), a shorter hospital stay (about 24 hours), a faster recovery, and no large scars. Time and experience will prove whether this procedure will eliminate the long-term risk of an aneurysm's bursting.
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