Category: Aneurysms

Orthopedic surgeon Dr. William Farrell has surgery

Article Source:

Updated: November 16, 2011 12:16PM

JOLIET — Provena Saint Joseph orthopedic surgeon Dr. William Farrell has performed hundreds of surgeries over his career, but four years ago, he went under the knife himself in an emergency open-heart surgery to save his life.

It was a turn-around and a new perspective for the surgeon, and an experience he will never forget.

It was a cold day in December when Farrell had his surgery to repair a dissecting thoracic aortic aneurysm and to replace a valve, but it took him more than a week to make the decision to have a new pain checked out. Physicians, it seems, can be much like their patients when it comes to taking health changes seriously.

“Doctors don’t run to their doctors any more than anyone else,” he said with a laugh.

But looking back, Farrell was told he was fortunate he didn’t lose his life during those few days before he went in for a check-up. The condition was serious.

A thoracic aortic aneurysm is when a weak area on the aorta — the large artery coming out of the heart — bulges out or expands. They are so dangerous because they can burst at any time, causing severe internal bleeding leading rapidly to shock or death.

Farrell said when one bursts, survival rates are low. According to the Society for Vascular Surgery’s website, only about 20 percent to 30 percent of patients who get to the hospital with a ruptured thoracic aneurysm survive.

Even if the vessel ruptured on the table of an operating room, Farrell said, the patient might not survive.

“The quickest you can crack a chest is five minutes,” he said.

Only about half of patients with the condition even have symptoms. Those who do might notice chest or back pain, pain in the jaw or neck, coughing, hoarseness, or difficulty breathing.

A dissecting aneurysm, which was Farrell’s type, occurs when blood flow forces the layers of the aorta apart, weakening the aorta.

Farrell’s symptoms began with an ache in his upper back — not something most would equate with a dangerous heart condition. He thought it was probably a virus coming on and kept practicing. The backache persisted, though, and what he describes as his “coup de gras” was a shortness of breath walking from his car into the hospital.

An echocardiogram followed by a CT scan showed the presence of the aneurysm. Farrell took the news seriously, but perhaps not surprisingly to those who know him, he also had a calm come over him that he attributes to his strong faith.

“I was very much at peace,” he said of learning he was on his way to open-heart surgery. “It was like it was meant to be. I knew it was something I would just have to deal with. I just felt an aura of peace.”

Farrell said his father, who had the same condition, passed away at the age of 50 on the exact date Farrell was diagnosed. His surgery was Dec. 8 — the day of the Feast of the Immaculate Conception, which was an important observance to Farrell. He had always felt a connection to the Virgin Mother.

“It was meant to be,” he said. “I have a devotion to her, and I think that’s part of it. It was her way of saying thank you … I believe she intervened for me on my behalf. I feel I owe my life to that intercession.”

Farrell was admitted to Provena Saint Joseph immediately, where two medical school buddies of his, Drs. Rudy Altergott and Brian Foy, who founded Provena’s open-heart surgery program 16 years prior, performed the procedures.

It was successful, and he returned to work slowly after a recovery of around three months. Today, he said he’s as good as ever.

“I am working as hard as I used to,” he said.

Farrell said if he learned anything from his experience that he could pass on, it would be to live life in peace.

“None of us know when our last days will be,” he said. “Tomorrow might be your last day. Get rid of the bitterness in your heart and be at peace with other people and with yourself. Why carry bitter baggage around?”

Additional source: www.vascularweb.org.

Dave Leighton-56

Name: Dave Leighton
Email: bogeyebe@frontier.com
Age at time of Dissection: 56
Type of Dissection: Ascending
Date of Aortic Dissection: 13 January 2011
Tell Us Your Story:

My Ascending Aortic Dissection occurred on the night of Jan 13th, 2011. At approximately 9:00 pm I was watching ESPN downstairs and was suddenly experiencing severe pain in my chest. It didn’t take long to decide this was serious. I stumbled upstairs, grabbed the phone, and dialed 911. I then ventured down the hall to wake up my wife. In the 15 minutes it took for the local Fire Department medics to get to my home, I’d dialed 911 two more times….I was in that much discomfort.

After arrival, the Medics hooked me up to their monitors and quickly determined that I was not having a heart attack, which may explain their non-emergency (no lights or siren, speed limit all the way) transport of me to Valley General Hospital in Monroe, WA.
I believe a lot of credit for my survival goes to the E-Room Doctor at Valley General (I wish I knew her name). She made the decision quickly to get me into the CT Scan. Once that determined a dissecting aneurysm, things started happening very fast.

The Dr. rushed into the exam area I was in and explained that what I had was very serious, that I was about to have open heart surgery, and that a Cardiac Surgeon was waiting for me at Providence Regional Medical Center, Everett, WA. In no time they had loaded me into another ambulance, so, now I get to cross the screaming siren and lights ambulance ride off my bucket list.
It turns out the Cardiac Surgeon waiting at Providence to save my life is my neighbor from a couple of houses away, Dr. Patrick Ryan who did and awesome job putting me back together and saving my life.


When I woke up the next day in recovery I’m not sure I immediately remembered what had happened. I certainly didn’t know that I was now the proud new owner of a St. Jude’s carbon aortic valve and matching Dacron sleeve replacing part of my ascending aorta. I got that news from the nurse, Rick, who was taking great care of me….

In general I feel like the progress of my recovery has been excellent, although it’s sometimes hard to be patient waiting to get back to where I feel “100% normal” again……I feel truly blessed by grace of God to have survived something this serious. I’ve lost two co-workers and friends in the last two years to aortic aneurysms…….

Thanks for stopping by to view our stories. Please help me keep the site going by shopping at Amazon.com-It’s very much appreciated. Brian Tinsley founder of AorticDissection.com (please book mark the link once you get to Amazon.com for future purchases!)

The Daily Checkup: Keeping aneurysms from reaching the breaking point


Here’s a great article from my friend, Dr. Gabriele Di Luozzo:

The specialist: Dr. Gabriele Di Luozzo on aortic aneurysms

Dr. Gabriele Di Luozzo is associate director of Mount Sinai Hospital’s Aortic Aneurysm Program, one of the largest of its kind in the U.S., overseeing 150 to 200 complex aortic operations every year.

Who’s at risk

An aneurysm is a general term that doctors use when part of an artery widens or balloons out as the result of weakness in blood vessel walls, an event which can occur anywhere in the body.

“A thoracic aortic aneurysm is an aneurysm or ballooning of the aorta that is confined to the chest cavity,” says Di Luozzo. “If left untreated, large aneurysms can lead to rupture and death.” About 10,000-20,000 Americans are diagnosed with thoracic aortic aneurysms each year.

There are about 3,000 new cases of acute aortic dissections diagnosed every year, although this number may underestimate the true number of people affected by the disease.

An acute aortic dissection occurs when the inner lining of the aorta separates from the other layers of the aortic wall, creating a new passageway for blood. This immediately weakens the aorta and can lead to death.

Who’s at risk

The most common causes of thoracic aortic aneurysms are high blood pressure, smoking and genetics. “These aneurysms are more common in men than in women, and usually occur in the sixth or seventh decade of life,” says Di Luozzo.

“However, patients with the genetic predisposition can develop thoracic aortic aneurysms as early as adolescence or early adulthood,” says Di Luozzo.

Patients known to have an abnormally developed aortic valve are at a higher risk of developing the condition.

Signs and symptoms

Thoracic aortic aneurysms catch most patients completely off guard.

“Unfortunately, the majority of aneurysms are silent and grow undetected for many years,” says Di Luozzo. “Usually they’re found incidentally, when the patient has an imaging study for a different medical condition.”

Most of these aneurysms are detected by a chest X-ray, echocardiogram or CT scan. CT scans or MRIs are considered the most precise methods of evaluating the aneurysm. In some cases, patients develop symptoms that are fairly unspecific to the aneurysm.

“Patients can have dull chest pain, shortness of breath, back or abdominal pain,” says Di Luozzo. “Occasionally they develop a change in the character of their voice.” The symptoms of aortic dissections are very similar to having a heart attack. Doctors hope that in the future they will be able to pinpoint who is at risk, but currently most diagnoses remain incidental.

Traditional treatment

Treatment options depend on the aneurysm’s size, location and underlying cause, as well as the patient’s age and general health.

“The majority of patients can be treated medically by controlling their blood pressure, avoiding strenuous activities and lowering their cholesterol,” says Di Luozzo. “A key to recovery is to stop smoking, in order to reduce the likelihood the aortic aneurysm will expand.”

Patients with large aneurysms have the option of open surgery or endovascular stents. “In surgery, the portion of the aorta where the aneurysm is located is removed and replaced with a synthetic tube to reconstruct the aorta,” says Di Luozzo.

“In the endovascular procedure, the stent is placed using a catheter that travels to the aorta through an artery in the leg,” he says. The stent provides the aorta with a new lining. Modern aneurysm surgery and endovascular stenting approaches to thoracic aortic aneurysms are safe.

“The risk depends on the location of the aneurysm, the extent of damage to the aorta, age of the patient, and complicating medical problems,” says Di Luozzo.

“Surgical risk can be as low as 2%-3% or as high as 5%-8%; for the endovascular procedure it’s about 5%.”

However, not having surgery can carry an even higher risk of thoracic aortic aneurysms rupturing. “An aneurysm with a 6-centimeter diameter has a 10% risk of rupture per year,” says Di Luozzo. “Larger thoracic aortic aneurysms have a 50% rupture risk within three years if untreated.” Surgery and endovascular procedures are very effective at preventing ruptures.

The only follow-up required of patients is a yearly checkup with CT scan or MRI and continued efforts to manage blood pressure and cholesterol. Patients with aortic aneurysms that are not large enough to need immediate repair should be seen at an aortic center regularly and have a CT scan or MRI. A formal aortic surveillance program, like Mount Sinai’s, specializes in monitoring and repairing patients’ aneurysms safely.

Research breakthroughs

“Our research has allowed us to improve the protection of the brain and spinal cord during these particular operations,” says Di Luozzo.

“We’re also gathering more information regarding the genetic component of thoracic aneurysms — which we hope will help us determine better who may be at risk.”

Additionally, thousands of patients, over the last decade, have benefited from the advancement of catheter-based treatments of thoracic aortic aneurysms and dissections.

Questions for your doctor

If you’re diagnosed with a thoracic aortic aneurysm, the first question to ask is, “Can my aneurysm be treated medically?” If your aneurysm does require intervention, ask “Is open surgery or an endovascular procedure my best option?”

Because the surgeon’s experience level can make a huge difference, be sure to ask, “How many of my procedures do you perform a year?”

Once Is Not Enough With Endo AAA Repair

By Todd Neale, Staff Writer, MedPage Today
Published: January 03, 2011
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner Earn CME/CE credit
for reading medical news
Reinterventions and readmissions occur more frequently after endovascular abdominal aortic aneurysm (AAA) repair than after open repair — partly explaining why the early survival benefit seen with the endovascular approach disappears over time, researchers found.

Complete article here:

A study of more than 45,000 Medicare patients who underwent elective AAA repairs over a three year period found that major and minor reinterventions were more common with endovascular repair (0.4 versus 0.2 per 100 person-years, P<0.001), according to Marc Schermerhorn, MD, of Beth Israel Deaconess Medical Center in Boston, and colleagues.

Ruptures were uncommon, but also occurred at a higher rate following endovascular repair (0.5 verus 0.1 per 100 person-years, P<0.001), the researchers reported in the January issue of the Journal of Vascular Surgery.
Action Points

* Explain that among patients undergoing abdominal aortic aneurysm (AAA) repair, reinterventions and readmissions occur more frequently after endovascular versus open surgical repair.

* Note that these results partly explain why the early survival benefit seen with the endovascular approach disappears over time.

* Explain that ruptures were uncommon but also occurred at a higher rate following endovascular repair and had a 30-day mortality rate of 28%.

The findings likely provide at least a partial explanation for the erosion of the early survival benefit with the endovascular approach, Schermerhorn and co-authors suggested.

“The overall cumulative and long-term effect of these reinterventions and the higher rate of subsequent rupture after [endovascular repair] likely contribute to but do not fully explain the equalization of overall survival during the follow-up period after AAA repair,” the researchers wrote, “because 2% more deaths during follow-up were attributable to reinterventions and readmissions in the endovascular AAA repair (EVAR) group compared with open repair.”

They noted that age, congestive heart failure, and renal failure also likely contribute to the observed loss of survival benefit over time.

To look at the relationship between reinterventions and readmissions after initial AAA repair, Schermerhorn and his colleagues analyzed claims data from 45,652 Medicare beneficiaries who underwent elective AAA repairs from 2001 to 2004.

The median age of the participants was around 76. The most common comorbidities in the study patients were hypertension, chronic obstructive pulmonary disease, and peripheral aterial disease (PAD).

Through up to six years of follow-up, overall reinterventions or readmissions were slightly more common following endovascular repair (7.6 versus 7.0 per 100 person-years, P<0.001). The overall 30-day mortality rate with any reintervention of readmission was 9.1%.

Patients who underwent endovascular repair had more of the following outcomes (with rates per 100 person-years). All differences were significant at P<0.001:

* Ruptures: 0.5 versus 0.1, with a 30-day mortality rate of 28%
* AAA-related reinterventions: 3.7 versus 0.9, with a mortality rate of 6.2%
* Minor open reinterventions: 0.8 verus 0.5, with a mortality rate of 7.2%
* Major AAA-related interventions: 0.4 versus 0.2, with a mortality rate of 13.7%

Patients treated with the endovascular approach had fewer laparotomy-related reinterventions than patients treated with the open approach (1.4 versus 3.0 per 100 person-years) and fewer readmissions for bowel obstruction or ileus without surgery (2.0 versus 2.7) (P<0.001 for both).

Overall, reinterventions or readmissions accounted for 9.6% of all deaths following endovascular repair and 7.6% of deaths following open repair (P<0.001).

The authors noted some limitations of their study, including those inherent to the use of administrative data, such as coding error and lack of clinical detail. The researchers were also unable to consider anatomic differences among patients and how they may relate to the risk of reintervention or readmission within the study.

While patients with PAD were more likely to have a reintervention or readmission, they “did not identify prior surgical procedures for this condition, which may further predispose patients to some of the AAA-related reinterventions we used as outcomes,” the team wrote.

“Future work should attempt to identify predictors of reintervention or readmission to factor this into clinical decision algorithms,” Schermerhorn and co-authors concluded.

The study was supported by an NIH T32 Harvard-Longwood Research Training in Vascular Surgery grant.

Schermerhorn has received an unrestricted educational grant from Gore, is on the data safety monitoring board for Endologix, and is a consultant for Medtronic. One of his co-authors has received an unrestricted educational grant from Gore.

Primary source: Journal of Vascular Surgery
Source reference:
Giles K, et al “Thirty-day mortality and late survival with reinterventions and readmissions after open and endovascular aortic aneurysm repair in Medicare beneficiaries” J Vasc Surg 2010; DOI: 10.1016/j.jvs.2010.08.051.

Thirty-day mortality and late survival with reinterventions and readmissions after open and endovascular aortic aneurysm repair in Medicare beneficiaries

UK Scarborough Hospital AAA Issues with patients

Concern over Scarborough and North East Yorkshire Health Care’s operation death rate

8:41am Wednesday 16th June 2010

A NORTH Yorkshire hospital which had a death rate of 28 per cent for a particular operation has said it is unable to comment following a call for an inquiry.

Newly released figures show that operations to correct a swollen artery – or abdominal aortic aneurysm – carried out by Scarborough and North East Yorkshire Health Care had a death rate of 28.6 per cent. The national average is four per cent.

The statistics show that from 2006 to 2008, the authority, which runs hospitals in Scarborough and Bridlington, carried out 14 of the operations, resulting in the deaths of four patients.

It stopped offering the procedures in 2009 after the high death rate was highlighted.

Research has now shown that hospitals which perform only a small number of the operations each year have much higher death rates because they are less practised in the procedure.

But a call for an inquiry by Peter Walsh, the chief executive of Action Against Medical Accidents, into the death rate has gone unanswered. A Scarborough and North East Yorkshire Health Care spokeswoman said she had been unable to get a comment from the medical director.

But she added: “In March 2009 Scarborough and North East Yorkshire Healthcare NHS Trust noted an alert on the Dr Foster monitoring tool against elective aortic aneurysm repair in our hospital.

“We immediately stopped both elective and emergency aortic aneurysm repair and looked further at our mortality rate and volume of surgery.”

At York Hospital, the death rate for the operations was 7.1 per cent for the same period, with 85 people undergoing the operation and six deaths resulting.

Stephen Cavanagh, consultant vascular surgeon at York Hospitals NHS Foundation Trust, said the figures varied from year to year and currently the death rate for this type of procedure was 4.7 per cent.

He also said data submitted to the database was not independently verified and not all units submitted their data in the same way so it was difficult to draw comparisons.

He said: “This is a high-risk procedure. However, the figures provided are not risk-adjusted to take into account people who have more complex aneurysms to fix, or who are particularly unfit, or both.

“The data also does not record the outcome for people who do not undergo surgery.

“By denying high-risk patients surgery, the outcome data figures will be improved, but these untreated patients may rupture their aneurysm, which is often a fatal event with around 75 per cent mortality.

“Ultimately, we try to select patients for surgery to give them the best chance of a successful outcome, and prevent rupture of their aneurysm.

“In keeping with national trends, we are now performing more endovascular aneurysm repairs, with significantly lower mortality rates.”

Aortic Aneurysms

source: The Society of Thoracic Surgeons

What are Aortic Aneurysms?

An aortic aneurysm is an abnormal bulge in the wall of the aorta, the body’s largest artery (the blood vessel that carries oxygen-rich blood). Roughly the diameter of a garden hose, this artery extends from the heart down through the chest and abdominal region, where it divides into a blood vessel that supplies each leg. Although an aneurysm can develop anywhere along your aorta, most occur in the section running through your abdomen (abdominal aneurysms). The rest occur in the section that runs through your chest (thoracic aneurysms).

The weakened artery wall may stretch as blood is pumped through it from the heart. The bulge or ballooning may be symmetrical (fusiform). Occasionally an aneurysm may occur because of a localized weakness of the artery wall (saccular). Enlargement of the aorta may be only mild in degree and termed “ectasia.” In general, if the diameter of the aneurysm is more than 1.5 times the size of the normal aorta, it is called an aneurysm.

An aortic aneurysm is serious because – depending on its size – it may rupture, causing life-threatening internal bleeding. The risk of an aneurysm rupturing increases as the aneurysm gets larger. The risk of rupture also depends on the location of the aneurysm. Each year, approximately 15,000 Americans die of a ruptured aortic aneurysm. When detected in time, an aortic aneurysm can usually be repaired with surgery.

Types of Aortic Aneurysms

Aortic aneurysms are classified by shape, location along the aorta, and how they are formed. The wall of the aorta is made up of three layers: a thin inner layer of smooth cells called the endothelium, a muscular middle layer which has elastic fibers in it called the media, and a tough outer layer called the adventitia. When the walls of the aneurysm have all three layers, they are called true aneurysms. If the wall of the aneurysm has only the outer layer remaining, it is called a pseudoaneurysm. Pseudoaneurysms may occur as a result of trauma when the inner layers are torn apart.

Shape

  • Fusiform aneurysms

    Most fusiform aneurysms are true aneurysms. The weakness is often along an extended section of the aorta and involves the entire circumference of the aorta. The weakened portion appears as a generally symmetrical bulge.

  • Saccular aneurysms

Saccular aneurysms appear like a small blister or bleb on the side of the aorta and are asymmetrical. Typically they are pseudoaneurysms caused either by trauma (such as a car accident) or as the result of a penetrating aortic ulcer.


Used with the permission of Mayo Foundation

Cause

  • Degenerative aneurysms

    Degenerative aneurysms are the most common types of aneurysms. They occur as the result of breakdown of the connective tissue and muscular layer. The cause could be cigarette smoking, high blood pressure and/or genetic conditions.

  • Dissecting aneurysms

    Dissecting aneurysms occur when a tear begins within the wall of the aorta, causing the three layers to separate. This is similar to what happens to a sheet of plywood that is left out in the weather. The dissection (separation of the layers) causes the wall of the aorta to weaken, and the aorta enlarges. Dissections may occur any place along the aorta and treatment depends upon the location. Frequently, those involving the ascending aorta are treated with emergency surgery while those involving the descending thoracic aorta are treated with medication. Although dissections are uncommon, they are the most common of the acute aortic syndromes. They are lethal if left untreated.

Used with the permission of Mayo Foundation

Location

  • Thoracic aortic aneurysms

    The aorta is shaped like an old-fashioned walking cane with the short stem of the curved handle coming out of the heart and curling through the aortic arch which gives off branches to the head and arms. Then the aorta descends through the chest cavity into the abdomen and separates off to provide blood to the abdominal organs and both legs. Thoracic aneurysms can occur anywhere along the aorta above the diaphragm, including the ascending aorta, the aortic arch, and the descending thoracic aorta. In general, thoracic aortic aneurysms are treated by thoracic surgeons.

  • Abdominal aortic aneurysms

    Abdominal aortic aneurysms are located along the portion of the aorta that passes through the abdomen. Continuing from the thoracic aorta, the abdominal aorta carries blood down through the abdomen until it eventually splits off into two smaller arteries that provide blood to the pelvis and legs.

    Abdominal aortic aneurysms are far more common than thoracic aortic aneurysms, comprising up to 75 percent of aortic aneurysms. They can affect anyone, but are most often seen in men ages 40 to 70. Most abdominal aortic aneurysms are caused by atherosclerosis.


Used with the permission of Mayo Foundation

What causes Aortic Aneurysms?

Aortic aneurysms are most often caused by damage to the artery’s wall due to atherosclerosis, commonly known as hardening of the arteries. Atherosclerosis is caused by a buildup of cholesterol and other fatty deposits in the arteries and hypertension (high blood pressure). Other causes of aortic aneurysms may include:

  • Congenital weakness of the artery wall (something you are born with)
  • Weakening of the artery wall from smoking or high blood pressure
  • Dissection or tearing of the artery wall
  • Trauma (usually falls or motor vehicle accidents)

Sometimes the cause of an aneurysm is not clear. Aneurysms may be hereditary.

What are the symptoms of Aortic Aneurysms?

Most aortic aneurysms have no symptoms. In fact, most are diagnosed on a chest X-ray or computerized tomography (CT) scan performed for evaluation of another condition, such as lung disease, or during routine exams. Symptoms may occur, however, due to the aneurysm pressing on nearby organs or tissue, or if the aneurysm leads to dissection. Symptoms of dissection include severe tearing pain in the chest or back, stroke, cold or numb extremities, or abdominal pain.

Abdominal aortic aneurysms may be diagnosed by a doctor during a physical exam, or sometimes patients notice a pulsating mass in their abdomen. The first hint of an aortic aneurysm may be an abnormal chest X-ray. Other tests that may be done to diagnose an aneurysm include:

  • Echocardiography
  • Computerized tomography (CT)
  • Magnetic resonance imaging (MRI)

How are Aortic Aneurysms treated?

Treatment for an aneurysm depends on its size and location and your general health. If the aneurysm is small and you have no symptoms, your physician may suggest a “watch-and-wait” approach with regularly scheduled images of the aneurysm to check the size. However, if your aneurysm is large enough, or if the aneurysm is growing more than 1 centimeter (cm) per year, surgery may be your best option. Your health-care provider will work with you to evalulate the risks of rupture and the risks of surgery.

Medical Treatment of Aortic Dissections

The aorta is composed of three layers. Aortic dissections occur when the layers separate (the way plywood will separate if left out in the rain). When dissections occur, patients typically experience severe pain in the chest or back which may be described as tearing discomfort. This most frequently takes them to the emergency room, where the diagnosis may be made.

Dissections may involve the ascending aorta alone, the descending thoracic and abdominal aorta alone, or the entire aorta. The risk of death depends on the extent of the dissection. It is highest for those aneurysms involving the ascending aorta. For that reason, most of these aneurysms are treated surgically as an emergency. Dissections of the descending thoracic aorta can often be treated with blood pressure control. The medical treatment of aortic dissection includes aggressive control of blood pressure and heart rate while the aorta heals. The risk of death with medical treatment of descending thoracic aortic dissection is about 10 percent. If surgery is required, however, the risk is higher at about 30 percent. Every effort is therefore made to treat these patients with medication.

Once the acute dissection has healed, adequate control of blood pressure may eliminate the need for surgery. Lifelong monitoring of diameter of the aorta is required because a previously dissected descending thoracic aorta may enlarge and rupture.

Open abdominal or open chest surgery

The accepted standard treatment for aneurysm once it meets the indications for surgery is replacement of that portion of the aorta with an artificial graft. Typically a graft is made from DacronTM, a material that will not wear out. The graft is sewn in place with a permanent suture material.

The operation, including the incision that is made, depends on the location of the aneurysm. If the aneurysm is close to the aortic valve, an incision in the front of the chest such as a median sternotomy may be used. If the aneurysm is close to the valve, the aortic valve may have to be repaired or replaced. Surgery on the aortic arch is usually done from the front as well. If the aneurysm involves the descending thoracic aorta, which lies in the left chest, or the thoracic abdominal aorta, an incision on the left side of the chest will likely be required. If the aneurysm is confined to the abdomen, then an incision either in the abdomen, or on the side or flank may be used.

Endovascular surgery

In recent years, a treatment has been developed to repair an aneurysm without major surgery. Many surgeons have been using less invasive endovascular surgery on abdominal aortic aneurysms. The procedure results in less blood loss, less trauma to the aorta, and fewer (or no) days in intensive care. Because results with endovascular repair of abdominal aortic aneurysms have been encouraging, similar techniques are being developed for the treatment of thoracic aortic aneurysms as well.

Endovascular surgery may benefit those who need surgery but are at high risk of complications because of pre-existing medical problems. However, not every person is a good candidate for this procedure. The appropriate choice of procedure, open versus endovascular, depends on many factors and is best determined by the medical team in consultation with the patient.

In endovascular surgery, a synthetic graft (stent-graft consisting of a polyester tube inside a metal cylinder) is attached to the end of a thin tube (catheter) that is inserted into the bloodstream, usually through an artery in the leg. Watching the progress of the catheter on an X-ray monitor, the surgeon threads the stent-graft to the weak part of the aorta where the aneurysm is located.
Once in place, the graft is expanded. The stent-graft reinforces the weakened section of the aorta to prevent rupture of the aneurysm. The metal frame is expanded like a spring to hold tightly against the wall of the aorta, cutting off the blood supply to the aneurysm. The blood now flows through the stent-graft, avoiding the aneurysm. The aneurysm typically shrinks over time.

What is the prognosis for an aortic aneurysm?

Medical Treatment of Aortic Dissections

The risk of death with medical treatment of descending thoracic aortic dissection is about 10 percent. If surgery is required, the risk is higher, however, at about 30 percent. Every effort is therefore made to treat these patients with medication.

Once the acute dissection has healed, adequate control of blood pressure may eliminate the need for surgery. Lifelong monitoring of diameter of the aorta is required because a previously dissected descending thoracic aorta may enlarge and rupture.

Open abdominal or open chest surgery

The length of the operation and the risks involved depends on the extent of the repair required, and on the patient’s general health. Recovery time varies. Most people need at least a month or six weeks to recover from aneurysm surgery. The length of the hospital stay depends on the patient’s condition and the operation performed, but it is typically a week.

Endovascular surgery

Although endovascular surgery reduces recovery time to a few days, it still carries risk. And because the procedure is fairly new, long-term results are unknown. Complications can occur with this procedure, namely blood leaking from the graft, known as endoleak. For this reason, patients who have repair of their aortic aneurysms with stent-grafts are initially required to return for monitoring every six months.

Types of Aneurysm

I found this at this source page:

Types of Aneurysm

Aortic Aneurysms

The two types of aortic aneurysm are abdominal aortic aneurysm (AAA) and thoracic aortic aneurysm (TAA).

Aortic Aneurysms

Figure A shows a normal aorta. Figure B shows a thoracic aortic aneurysm (which is located behind the heart). Figure C shows an abdominal aortic aneurysm located below the arteries that supply blood to the kidneys.

Figure A shows a normal aorta. Figure B shows a thoracic aortic aneurysm (which is located behind the heart). Figure C shows an abdominal aortic aneurysm located below the arteries that supply blood to the kidneys.

Abdominal Aortic Aneurysms

An aneurysm that occurs in the part of the aorta that’s located in the abdomen is called an abdominal aortic aneurysm. AAAs account for 3 in 4 aortic aneurysms. They’re found more often now than in the past because of computed tomography (to-MOG-rah-fee), or CT, scans done for other medical problems.

Small AAAs rarely rupture. However, an AAA can grow very large without causing symptoms. Thus, routine checkups and treatment for an AAA are important to prevent growth and rupture.

Thoracic Aortic Aneurysms

An aneurysm that occurs in the part of the aorta that’s located in the chest and above the diaphragm is called a thoracic aortic aneurysm. TAAs account for 1 in 4 aortic aneurysms.

TAAs don’t always cause symptoms, even when they’re large. Only half of all people who have TAAs notice any symptoms. TAAs are found more often now than in the past because of chest CT scans done for other medical problems.

With a common type of TAA, the walls of the aorta weaken, and a section close to the heart enlarges. As a result, the valve between the heart and the aorta can’t close properly. This allows blood to leak back into the heart.

A less common type of TAA can develop in the upper back, away from the heart. A TAA in this location may result from an injury to the chest, such as from a car crash.

Other Types of Aneurysms

Brain Aneurysms

When an aneurysm occurs in an artery in the brain, it’s called a cerebral (seh-RE-bral or SER-eh-bral) aneurysm or brain aneurysm. Brain aneurysms also are sometimes called berry aneurysms because they’re often the size of a small berry.

Brain Aneurysm

The illustration shows a typical location of a brain (berry) aneurysm in the arteries supplying blood to the brain. The inset image shows a closeup view of the sac-like aneurysm.

The illustration shows a typical location of a brain (berry) aneurysm in the arteries supplying blood to the brain. The inset image shows a closeup view of the sac-like aneurysm.

Most brain aneurysms cause no symptoms until they become large, begin to leak blood, or rupture. A ruptured brain aneurysm causes a stroke.

Peripheral Aneurysms

Aneurysms that occur in arteries other than the aorta and the brain arteries are called peripheral aneurysms. Common locations for peripheral aneurysms include the popliteal (pop-li-TE-al), femoral (FEM-o-ral), and carotid (ka-ROT-id) arteries.

The popliteal arteries run down the back of the thighs, behind the knees. The femoral arteries are the main arteries in the groin. The carotid arteries are the two main arteries on each side of your neck.

Peripheral aneurysms aren’t as likely to rupture or dissect as aortic aneurysms. However, blood clots can form in peripheral aneurysms. If a blood clot breaks away from the aneurysm, it can block blood flow through the artery.

If a peripheral aneurysm is large, it can press on a nearby nerve or vein and cause pain, numbness, or swelling.

Aneurysms-various links about them

Aneurysms
      Aneurysm, Thoracic
      Aortic Aneurysm
      2004 Pulitzer Prize winning artilces on aneurysms
      Abdominal Aortic Aneurysm
      Thoracic Aortic Aneurysm

Thanks,

Brian

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