Aneurysm Treatment

Aneurysm repair in the 21st Century

The first aneurysm repairs were performed in the 1950's using fabric tubes that were inserted into the abdomen to replace the diseased segmentsof artery. This required a long incision in the abdomen, and patients commonly spent 5-7 days in hospital, including a few days in the intensive care unit. This operation has been performed successfully since then, but it is highly invasive, often necessitating a long recovery times after discharge, and has a small but not insignificant risk of serious complications.

More recently, vascular surgeons have developed and refined a minimally invasive method of repairing aneurysms, known as endovascular aneurysm repair (or EVAR). This involves placing a stent inside your aorta to reinforce the damaged artery, channelling the blood flow away from the weakened artery walls. This is achieved via small groin incisions, or increasingly through tiny punctures in your skin. This method is associated with less complications during the initial period after treatment, and you can go back to a normal life much earlier than was previously possible.

Diagnosis and investigation

If your doctor suspects that you have an aneurysm, you will be sent for an ultrasound scan to confirm the diagnosis. If it is large enough that surgery might be necessary, you will be invited to have a CT scan. This involves lying still for a few minutes while a circular x-ray machine rotates around you. You will have to have an injection of dye, which may make you feel warm and flushed for a few seconds. If the aneurysm is small, you will be entered into a surveillance program of regular check-ups to monitor the size of your aneurysm. If it is determined that you will soon need to have your aneurysm repaired, a variety of other assessments may need to be performed to assess your fitness for surgery. These can include scans of the heart and breathing tests.

Surgical Procedures

The preferred way to repair an aneurysm is using keyhole, or endovascular surgery. The decision on whether you are able to have a endovascular repair is based on a number of factors including the shape of your aneurysm, the size of the blood vessels (the iliacs and femorals) that are carrying blood to your legs and whether the aneurysm involves blood vessels supplying other vital parts of your body (brain or organs).

Endovascular repair is generally carried out under a general anaesthetic. A stent graft is placed into your aorta via the femoral arteries, which are found in your groin. Often this can be done through a very small incision (percutaneously), but sometimes a small incision is required. The procedure usually takes approximately one hour.

If an open surgical operation is required, a long incision (or laparotomy) is made in the middle of your abdomen. The aneurysm is identified, and surgical clamps are put above and below it to prevent bleeding before it is opened up. A graft is then placed in place of the aneurysm and sewn to the healthy vessels. The incision is closed and you will then be taken to the intensive care unit for careful monitoring.


Rehabilitation


The medical information provided here is intended solely for patients of the London & Surrey Vascular Clinic, it is general information only and should not be used as a substitute for personal advice received when consulting your own surgeon face-to-face.