Once an aneurysm has been diagnosed, the treatment will depend on a number of factors, such as the size of the aneurysm and the overall health of the patient. Small aneurysms of less than 2 inches (5 centimeters) in diameter rarely rupture and may pose little risk. If the aneurysm grows to 5.5 centimeters or larger, however, physicians usually recommend treating them with surgery or with non-surgical stent-graft repair.
If the aneurysm is small and there are no symptoms, the doctor may recommend "watchful waiting." Periodic check-ups will be performed to watch for changes.
Treatment with Medication
If the aneurysm is small but there are symptoms, treatment may be required to prevent complications. Medication may be prescribed to lower blood pressure, or to relieve pain.
When an aneurysm reaches a certain size (about 2.2 inches or 5.5 centimeters) there is a danger that it will rupture. The traditional treatment has been to operate. A surgical incision is made in the abdomen. The surgeon cuts out the damaged part of the aorta and sews a synthetic (Dacron) tube in its place. Recovery from the operation, which is performed under general anesthesia, typically requires 8 to 10 days. People who have other serious medical problems may be poor risks for surgery.
Minimally Invasive Stent-Graft Repair
In recent years, interventional radiologists (IR) have developed a treatment to repair an aneurysm without surgery. An incision is made in the patient’s groin and a catheter (small tube ) is inserted into a blood vessel that leads to the aorta. A stent-graft (a Dacron tube inside a metal cylinder) is inserted through the catheter. Watching the progress of the catheter on an X-ray monitor, the interventional radiologist threads the stent-graft to the weak part of the aorta where the aneurysm is located.
With this technique, there is no need to make a large incision in the abdomen or to cut away the damaged section of blood vessel.
Once the stent-graft is in place, the metal cylinder is expanded like a spring to hold tightly against the wall of the blood vessel. The blood will now flow through the stent-graft, avoiding the aneurysm, which typically shrinks over time.
A stent-graft is threaded into the blood vessel where the aneurysm is located. The stent graft is expanded like a spring to hold tightly against the wall of the blood vessel and cut off the blood supply to the aneurysm.
Comparison with Surgery
According to a national study conducted at medical centers throughout the United States, interventional radiology stent-graft repair of abdominal aortic aneurysms has fewer complications than surgery, and allows people to be back on their feet in less time.
In days in the hospital, compared to less than 4 days for stent-graft repair using interventional radiology techniques. Patients undergoing stent-graft repair also experienced less blood loss and fewer (or no) days in the intensive care unit. Their average recovery time was 11 days, compared to 47 days with surgical repair.
Q: Which Treatment is Right for Me?
A: The best treatment for an abdominal aortic aneurysm (AAA) depends on a number of factors, including the size and location of the aneurysm, whether or not it is causing symptoms, and the age and general health of the patient. You should discuss all of these factors and any other questions you have with your primary care physician. You also may want to consult with an interventional radiologist to determine if you are a candidate for the non-surgical stent-graft repair procedure.
Q: How Are Other Types of Aneurysms Treated?
A: Currently, most thoracic aortic aneurysms are treated surgically. New research, however, shows that interventional radiology stent-graft treatment may also be appropriate for some patients with thoracic aneurysm. There are also interventional radiology treatments available for cerebral aneurysm. The best treatment for an aneurysm depends on a number of factors, including the size and location of the aneurysm, whether or not it is causing symptoms, and the age and general health of the patient. You should discuss all of these factors and any other questions you have with your primary care physician. You also may want to consult with an interventional radiologist to determine if you are a candidate for the non-surgical stent-graft repair procedure.
Source: Society of Interventional Radiology © 2003, www.SIRweb.org