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Aortic Aneurysm Repair

An aortic aneurysm occurs when a part of the aorta becomes too large or balloons outward. It occurs due to weakness in the wall of the artery. The aorta is the body's largest artery, from where oxygenated blood is pumped from the heart to the rest of the body.

An aortic aneurysm needs to be repaired, as left untreated there is a risk the artery will rupture. Since the artery is so large, the amount of internal bleeding resulting from this is usually fatal.

Thoracic aortic aneurysm repair involves an incision in the chest and the breast bone. The heart is then connected to the heart-lung machine and the aneurysm is repaired by the use of a long cylinder-like tube called a graft. The graft is sutured to the aorta connecting one end of the aorta at the site of the aneurysm to the other end of the aorta. The procedure is performed in an operating room under general anesthesia. This stops the buildup of pressure and ensures good blood flow through the artery, and significantly lowers the risk of rupture.

Aortic aneurysm repairs are required by men and women, especially those with Marfan's syndrome and bicuspid aortic valve. Having contributory lifestyles such as a high fat diet and smoking increases your risk. Diabetes, high blood pressure and family history of the illness are risk factors for developing an aortic aneurysm.

Aortic aneurysm repair with open surgery is usually reserved for those who have large aneurysms (generally over 5cm), the aneurysm is growing quickly (0.2cm per year), the risk of rupture is considered higher than the risks of surgery, or the aneurysm has a tear where emergency surgery is required.

In most cases, an aortic aneurysm produces no symptoms. If the aneurysm grows large enough, the patient may feel a pulsating sensation in their chest or develop pain in the chest or back area.

A ruptured aneurysm causes sudden and severe pain in the chest. This is a serious medical emergency and 999 should be called immediately.

An ultrasound called echocardiogram or even more sophisticated scans like CT and/or MRI can be used to view and measure your aorta, to confirm whether it has an aneurysm.

Since there are no symptoms, aortic aneurysms are generally detected through routine scans or examinations. An ultrasound can be used to view and measure your aorta, to confirm whether it has an aneurysm.

Alternative treatment options may involve lifestyle changes — moving onto a low cholesterol diet, losing weight, taking medication to lower blood pressure, and avoiding strenuous exercise so as not to put excessive pressure on your aorta.

There is also a less invasive treatment suitable for patients with smaller aneurysms, or who are unsuitable for more major surgery, known as endovascular aneurysm repair, or EVAR. This procedure is done in an operating room, in the radiology department of the hospital, or in a catheterisation lab and may be done under general anaesthetic or local/regional anaesthesic.

The surgeon makes a small incision near the groin, to find the femoral artery. Then your doctor will insert a stent (a metal coil) and a synthetic graft through the cut into the artery.

The doctor then uses X-rays to guide the stent graft up into your aorta, to where the aneurysm is located. The doctor will open the stent using a spring-like mechanism and attach it to the walls of the aorta. Your aneurysm will eventually shrink around it. The doctor will then use x-rays again to make sure the stent is in the right place and your aneurysm is not bleeding inside your body.

Aortic surgery can be marginally more risky than some other kinds of cardiac surgery, with the operative mortality rate at around 2-3%. The long-term outlook is good in patients whose ruptures were repaired without incident. Patients with untreated aneurysms over 5cm have an annual survival rate of only 20%.

Recovery depends on the health and age of the individual, but a full recovery may take 2 months or longer, with most people returning home 5-10 days after their operation. There will be a single scar on the chest area. There are limitations on heavily lifting and driving for up to six weeks after the operation.