What is aortic aneurysm repair?
Aortic aneurysm repair is a procedure used to prevent an aortic aneurysm from bursting. An aortic aneurysm is a bulging out of the wall of the aorta, the largest artery in the body, which runs from the heart through the chest and abdomen. Over time these bulges grow in size, and without treatment they may eventually rupture, causing massive internal bleeding that usually results in death.1
While not all aneurysms will burst, if you have a large or fast-growing aortic aneurysm you may need a procedure to repair it. Aortic aneurysm repair reinforces or replaces the aorta wall, preventing a potentially deadly rupture.
See also: Aortic Disease
Who might have an aneurysm repair procedure?
Large or fast-growing aneurysms are the most likely to rupture. If you have an aortic aneurysm that is large, growing quickly, or causing symptoms (such as pain, discomfort or a pulsing feeling in the abdomen) you should have an aneurysm repair procedure to prevent it from bursting.
A repair will usually be necessary if your aneurysm is larger than 2.2 inches (5.5 cm) or expanding more than 0.4 inches (1 cm) a year.1 Because women tend to have smaller aortas than men, a procedure may be considered if your aneurysm is 1.8 inches (4.5 cm) or larger.2
Who should not have an aneurysm repair?
Small aortic aneurysms are unlikely to burst, so the risks of a repair procedure are likely to outweigh the benefits for women with small or slow-growing aneurysms. Your doctor may recommend regular monitoring, instead of a repair procedure, if your aneurysm is smaller than 1.8 inches (4.5 cm). For men, the cutoff is 2.2 inches (5.5 cm).
Aneurysms that do not require immediate treatment are monitored using imaging tests (such as ultrasound) every 6 to 12 months. You will also need to make heart-healthy lifestyle changes and take medication to slow the growth of the aneurysm. See Aortic Disease Treatment Overview to learn more.
What is the prognosis after aneurysm repair?
Aneurysm repair procedures are an important tool to prevent a deadly rupture in women and men with large aneurysms, and they are becoming safer each year. In one study of 8,663 patients (17% were women) who had an aneurysm repair procedure, 69% survived for 5 years. The risk of problems is highest just after the procedure: 90% of those who survive the first few months live for at least 5 years.3
As with all procedures, aneurysm repair does carry risks. However, you will only have an aneurysm repair if your doctors decide that the risk of the aneurysm bursting is greater than the risk of the procedure. Approximately 20% of aneurysms larger than 5 cm, and 40% larger than 6 cm, will eventually burst. If your aneurysm does burst, your chances of survival are less than 1 in 10.1
How do doctors decide what type of procedure is best for me?
There are two main types of procedures used to repair an aortic aneurysm:
- Surgical ("open") aneurysm repair – a surgical procedure performed through an incision in your chest or abdomen
- Endovascular aneurysm repair – a newer, less-invasive procedure that repairs the aneurysm from the inside using a long, thin tube inserted through a blood vessel in your groin
A vascular surgeon can help you decide which type of procedure is best for you. Surgical aneurysm repair may be preferred in women who are healthy enough to have a low risk of problems during a surgical procedure, or whose aneurysms cannot be repaired with an endovascular technique. Endovascular repair may be the treatment of choice for women who have other medical conditions that make surgery too risky, or who simply want to avoid the pain and long recovery time associated with surgery.
Reprinted with permission from JAMA 302(18):2019.
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