Aortic Disease: How Are Aortic Aneurysms Treated?

The aorta is the largest artery in your body, responsible for carrying oxygen-rich blood directly from your heart to almost all parts of your body.

The longer lifespan seen in humans today, along with a large number of people with other risk factors (such as smoking), has created a situation where we see more diseases related to old age, such as atherosclerosis. It is a condition where plaque is slowly formed on the inside of your arteries, making them weaker over time. This eventually reduces the flexibility of your arteries, specifically the aorta. Under all that pressure, a part of the weakened aortic lumen expands permanently, and this is called an aortic aneurysm.

Aortic aneurysms can be located on every one of the five segments of the aorta:

The aortic bulb, arising from the left ventricle of the heart, and supplying the heart muscle.
The ascending aorta.
The aortic arch, which curves down and behind the heart, giving off branches that supply the head and the arms.
The descending (thoracic) aorta, with its branches.
The abdominal aorta, a part of the descending aorta beneath the diaphragm muscle, supplying the organs in the abdomen.

Although aneurysms are far more common in the abdominal part, they can form in either one of the locations throughout the aorta, frequently in the root of the ascending aorta and the descending part. The enlargement of different parts of the aorta usually causes little to no signs or symptoms, which presents a major problem, because as the aneurysm gets larger, it is more prone to complications.

These complications range from pain around the aneurysm area and compression of other organs, to severely dangerous ones, such as an aneurysm rupture. The rupture of an aortic aneurysm is an urgent medical condition, and requires immediate surgery. However, due to the fact that this is a major blood vessel, many patients often lose their blood and die before they even get the chance to receive the treatment.

If that doesn’t stop the growth of the aneurysm, there are two main approaches to aortic aneurysm treatment.

How do you treat an aortic aneurysm?

A lot of different factors need to be taken into consideration when evaluating the treatment of patients with an aneurysm, such as the size of the aneurysm, the risk of rupture, other possible chronic diseases the patient might have, the expected life span of the patient post-surgery, as well as the risk of surgery itself.

Although a surgical approach Is the only way the dilated aorta can return to normal, if the risk is high, or the aneurysm is relatively small in diameter, doctors usually recommend medications first, and surgery is reserved for patients showing heavy symptoms.

1. Medications used to manage aortic aneurysms

The most common underlying reason for the development of aortic aneurysms is atherosclerosis. So, the best way to prevent further aneurysm growth is to take care of your heart and your blood vessels.

Other than a healthy diet, along with frequent exercise (excluding heavy physical activities), your doctor will most likely prescribe you medications such as beta blockers, which make your heartbeats slower, thereby regulating pressure, and statins, which help by lowering cholesterol levels.

Both of these drug groups are proven to be helpful in reducing risks related to most cardiovascular related diseases. Other medications, such as ones used for lowering blood pressure or helping the aorta retain its elasticity, are also prescribed.

2. Surgical treatment

Open type surgery

Initially, all aortic surgeries were done in a classic way, the so-called “open type”, done under total anesthesia. The goal of this approach is to replace the problematic portion of the aorta with a synthetic part, called a graft. Although this general idea is the same when replacing either one of the parts of the aorta, the surgery of each aortic portion comes with it’s own challenges.

For example, when replacing the ascending aorta with a graft, a surgeon may need to reconstruct the aortic valve, whose purpose is to prevent blood already in the aorta from returning to the heart.

Aortic arch replacement comes with its own risks, because this part of the aorta gives arterial branches for the arms, neck, and head, including your brain. Because the brain can not survive very long without oxygen, special pumps, known as cardiopulmonary bypass (CBP) pumps, have been designed, which utilize tubes to continually replace blood in the organs in need with fresh, oxygenated blood.

Thoracic and abdominal aorta repairs also utilize similar methods involving the replacement of the aneurysmatic part of the vessel with a graft. Because the aorta is a major blood vessel, these surgeries demand very long recovery periods, which can last up to six months.

Endovascular surgery

Rapid developments in medical sciences have brought new methods of surgery, such as the endovascular aortic repair (EVAR). It is a minimally invasive surgical procedure where the stent is placed inside the aneurysmatic part of the aorta, thereby strengthening its wall. The procedure is done under local anesthesia, by positioning the stent via a catheter placed in one of the vessels in your groin area.

This type of procedure, although extremely convenient (primarily because the recovery period is minimal), can not replace classic surgery entirely, because some cases are more complicated than others, and therefore require open type surgery.

Despite the fact that these procedures are effective in regulating current aneurysmatic disease, they can only fix existing issues, and can not prevent possible future aneurysm development, nor the potential complications. To minimize the risk of complications, regular ultrasound checkups are recommended, usually once a year, depending on the size of the aneurysm. Meanwhile, you ought to lead a healthy lifestyle, while also regulating your blood pressure and cholesterol levels.

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