Enlargement of diameter of an artery by 50% of normal diameter is called aneurysm (ballooning). The cause is mostly the decrease of material giving flexibility to blood vessel wall with age. Most occurs in aorta which arises from the heart and supplies the legs and internal organs. The incidence increases with age. 50 people out of 100.000 at the age of 50 to 60 have aortic aneurysm and it goes up to 300 at the age of 70 to 80. Approximately 1.5% of the population at the age of over sixty-five is affected by this disease. It is more common in men than women as much as four times.
An aortic aneurysm is usually asymptomatic, or incidentally spotted during a routine examination or imaging procedures for other diseases (e.g. ultrasonography, computed tomography, MRI). Only a few presents symptoms. The abdominal pulse is palpable, or it may apply pressure on the adjacent organs.
Problems that may occur if untreated:
Aneurysm is feared because of its complications and an aortic aneurysm exceeding a certain diameter must be treated for the risk of such complications. An aneurysm can be ruptured; can damage the adjacent organ walls and bleed into these organs, or a clot comes off from the aneurysm and blocks the saphenous vessels. The most scared complication is the rupture and burst of aneurysm. The possibility of rupture is increased in direct proportion of increase in diameter of aneurysm. The studies show that the risk of rupture for an aneurysm larger than 50 mm is 5-7% a year while the rate of rupture for an aneurysm of 75 mm is 30% a year. Most ruptures are life threatening (mortality risk is 50-75% after a rupture). Each aortic aneurysm should be therefore operated, which is larger than 50 mm, if no medical obstacles are present.
Treatment includes two options, open surgery and endovascular aortic reconstruction (closed method).
The detailed computed tomography will help selecting the optimum treatment method.
• Open Surgery:
In an open surgery, the abdomen is opened and the aneurysm is repaired by placing an artificial vessel. This method is performed under general anesthesia.
• Endovascular Aortic Reconstruction (Closed Method):
In endovascular method, the patient is delivered a spinal anesthesia, or only groins are locally anaesthetized. This patient group usually includes elderly and those who have another disease so that the complications of general anesthesia can be avoided. Specific measurements are made on computed tomography taken prior to the procedure to measure the optimum size of artificial vessel for the patient. An incision of 5-8 cm is made on only two groins of the patient to prepare the inguinal artery. The artificial vessel supported with stents is guided through the aorta and inserted in the aneurysm and fixed with stents.
The patient needs to stay in the hospital for 2-3 days after the surgery. Computed tomography is required for annual checks.