Aortic Aneurysm Repair Surgery

A human heart functions like a pumping machine through the help of blood vessels, a method called ‘circulatory system’. These blood vessels are flexible muscular tubes that carry blood to all body parts. Blood vessels are of three major types namely Veins, Capillaries and Arteries. Arteries are the blood transporter of the body. Each artery is a muscular tube lined by smooth tissue and has three layers.

Aorta: The largest artery in the human body is known as ‘aorta’ that works like the main high-pressure pipeline connected to the heart's left ventricle. The aorta (artery) starts above the left ventricle of the human heart and goes down in front of the backbone to the abdomen and there it is divided into 2 smaller tubes known as iliac arteries.

Aneurysm: In medical terms, enlargement of a blood vessel is referred as ‘aneurysm.’ It is an unusual condition in which an artery swells like a balloon. Bulging can occur in any artery in the body however it is generally found in the arteries of the brain and in the abdominal aorta. Enlargement in an artery is classified as true aneurysm and false aneurysm (or dissection).

What is aortic aneurysm?

When there is balloon shape enlargement in the walls of aorta (main artery connected with the heart), it is called aortic aneurysm. The bulging can be anywhere but it mostly takes place in the stomach, chest or in the heart’s main pumping chamber (the left ventricle). The aneurysm of aorta is categorized as below:

• Abdominal Aortic Aneurysm (AAA)
• Thoracic Aortic Aneurysms (TAA)

Why aortic aneurysm happen?

Aorta, the artery is like a tube which is strong enough to carry blood in the body for life-time. But sometimes, the walls of aorta deteriorate and turn very weak. In such cases, the force generated from gushing blood within the aortic artery pushes fragile layer creating a puff towards outside. Initially aneurysm begins as a dent and keeps bulging outward with continued pressure of blood flow.

Is aortic aneurysm dangerous for life?

Firstly, aortic aneurysm is silently developed and often does not indicate specific symptom in the body. This condition proves to be risky as no precautionary action is taken till the situation reach to an unsafe point. Gradually puffiness towards outside can increase with time and balloon shape enlargement grows big in size. Some aortic aneurysms burst, some don’t. However even if aneurysm does not crack, it becomes the major reason for taking blood flow away from the organs and tissues which is harmful for heart and kidney. If the aneurysm burst then it can be hazardous to life due to internal bleeding which needs to be medically addressed swiftly.

What is aortic dissection?

Aortic Dissection (AD) is not bulging of the artery but it is similar to that as this condition is also related to internal bleeding. Due to weak and damaged blood vessel, the inner layer of aorta (artery wall) separates (rupture) allowing blood to leak between other layers. The dissection of artery layers calls for medical emergency as it leads to bursting of artery. Mostly men of old age group (60yrs and above) suffer from this condition.

What are the treatment options available for aortic aneurysm?

If a person feels uncomfortable and realizes that he/she has developed symptoms of having aortic aneurysm; proper medical diagnosis is required to confirm the actual condition. The cardiologist should be consulted for health-check up and medical evaluation. Suggested tests from the doctor can verify the location and size of the aortic aneurysm. Major threat of aortic aneurysm (bulging of artery) is sudden rupture which leads to internal bleeding and is life threatening. If it is not reached to bursting stage then medical management (monitoring) is the first step towards treatment.

The doctor can decide line of treatment to prevent the bulge from breaking and leaking of blood. However diagnosis at early stage can only give some time for the patient treating doctor to decide the type of treatment suitable for patient’s medical condition. Therefore surgery is the only treatment option to repair aortic aneurysm.

What are the types of aortic aneurysm repair surgery?

Aortic aneurysm surgery decision is based on many aspects such as overall health & age of the patient, size and location of the bulge. Aortic surgery is performed by the specialist doctors to repair aortic aneurysm and also replace part of the damaged aorta (artery). It can be either in the chest (for thoracic aneurysms) or the stomach area (for abdominal aneurysms). There are two types of surgery options although it is treating doctor’s decision to opt for the open or endovascular surgery.

Traditional Surgery: It is an operation in which the surgeon makes an incision at the aneurysm place. The bulging section of the aorta is removed and replaced with an artificial tube called a graft.

Endovascular Surgery: It is relatively latest and less invasive surgical procedure to repair an aneurysm. Doctors attach a synthetic graft to the end of a thin tube (catheter) that's inserted through an artery in your leg and threaded up into your aorta. Endovascular surgery result is equally effective however this is not suitable for all the patients.

What is endoaneurysmorrhaphy?

In some cases, surgeons do not cut out the bulging section of the aorta and line the damaged part, that is referred as ‘endoaneurysmorrhaphy’. It is a procedure which is same like the normal operation but the surgeon insert the fabric graft inside the aorta just like a supporting layer to reduce the pressure on the wall of the artery. Endoaneurysmorrhaphy is mostly performed on anterior-septal left ventricular (LV) aneurysms.