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An aortic aneurysm is a dilation or bulging of the aorta due to weak spots in the wall.

The aorta is the main artery that carries blood away from your heart to different parts of your body. All that blood pumping through can push against the weak spot in the artery wall. The pressure can make the artery wall bulge or balloon out.

If the bulging gets too large or the pressure is too great, the aneurysm can burst. This is called an “aneurysm rupture”. It’s a medical emergency and you need treatment right away.

But unruptured aneurysms may need treatment, too. Aneurysm repair surgery can prevent an aneurysm from bursting.

What Are the Different Types of Aortic Aneurysms?

If an aneurysm forms in the lower part of your aorta, it’s called an abdominal aortic aneurysm. These are the most common aortic aneurysms.

Aneurysms can also form in the upper part of the aorta in the chest. This is called a thoracic aortic aneurysm.

When Do You Need Aneurysm Repair Surgery?

Many people have unruptured aneurysms they never know about. These tend to be small aneurysms that cause no symptoms. Most aneurysms are found on a scan, such as a CT or MRI, while doctors are looking at something else.

However, our team at UPMC performs ultrasound scans to look for aortic aneurysms in people who might be at risk for developing them. We recommend getting a screening ultrasound if you are:

• A male over the age of 65 with any history of smoking
• Over the age of 65 with a history of aortic aneurysms in your family

If your doctor finds an aneurysm during a scan for something else, don’t panic. Not all aneurysms require surgery. Treatment for aneurysms depends on:

• Type of aneurysm (where it is).
• Your risk factors (like if you’re a smoker).
• Size of aneurysm.

Your doctor may monitor your aneurysm and prescribe medicine, like blood pressure and cholesterol medications. Part of your treatment may be making lifestyle changes, such as:

• Quitting smoking.
• Managing your stress.
• Getting more exercise.

The risk of bursting is very low for smaller aneurysms. However, for aneurysms that grow bigger than a certain size, your doctor may recommend aneurysm repair surgery. Large aneurysms have a high risk of bursting, and so repairing these aneurysms before the risk is too high can prevent bursting and the need for emergency surgery.

What Are the Types of Aneurysm Repair Surgery?

While procedures vary depending on where the aneurysm is, there are two main ways that doctors repair aneurysms. One is traditional open surgery and the other is a minimally invasive surgical procedure called endovascular aneurysm repair. Endovascular repair of an abdominal aneurysm is called EVAR, and repair of a thoracic aneurysm is called TEVAR.

Both are major procedures, requiring anesthesia and recovery time in the hospital. EVAR/TEVAR has a quicker recovery and less risk of bleeding but might require more minor surgeries in the future to fix leaks. Open surgery has a much longer recovery time but can last for longer with less need for more surgery in the future.

Open surgical repair for aneurysm

Open surgery is the more traditional surgical approach, with longer recovery time and a larger incision.

Open surgery for an aortic aneurysm means making a large incision in your stomach or chest. The surgeon then removes the aneurysm and sews a graft in place, which acts as an artificial artery. A graft is a piece of tubing made of a leak-proof material.

You will likely be in the hospital for a week or more after an open surgery. It can take several months to completely recover from open surgical repair. If the surgery was to treat a ruptured aneurysm, it may take you longer to recover.

Endovascular aneurysm repair (EVAR/TEVAR)

EVAR/TEVAR is a less invasive way to repair aortic aneurysms.

For some people, this is a better option than open surgery. For example, if a person isn’t strong enough to handle open surgery, EVAR may be safer. But the location or size of some aneurysms may not be as suitable for EVAR.

With EVAR, the surgeon makes a small cut or needle puncture in the groin area. Then, they thread a catheter (a thin, flexible tub) through your artery. Once they get to the site of the aneurysm, they send a stent graft through the catheter.

The stent graft is a tube covered with fabric. It expands and attaches to the wall of the aorta, sealing off the aneurysm so that blood can’t enter it. The blood flows into the stent graft instead. This relieves the pressure on the aneurysm and prevents it from growing larger or rupturing.

The recovery is quicker for EVAR than for open surgery. Many people go home the next day and are fully recovered within several weeks or a month. But once home, you’ll still need to take it easy and give your body time to heal.

Who Is at Risk for Aortic Aneurysms?

With most aneurysms, family history is a big risk factor. If you have a first degree relative with an aneurysm, you might be more likely to develop one.

You can develop an aneurysm at any time, but they are more common in older people. Most people with abdominal aortic aneurysms are 65 or older.

Other factors can increase your risk, such as:

Smoking.

High blood pressure.

High cholesterol.

Quitting or cutting down on smoking, controlling blood pressure, and taking statin medications for cholesterol are all excellent ways to prevent or slow the growth of an aortic aneurysm.

Have more questions about aortic aneurysms or aneurysm repair? Contact UPMC Heart and Vascular Institute.