Cheltenham Vascular Unit
What is an aortic aneurysm?
The aorta is the main blood vessel that comes from the heart; it ascends from the left side of the heart through the chest and into the abdomen where it divides into two branches know as the iliac arteries.
An aneurysm is a ballooning of this artery that occurs as a result of weakening of the arterial wall. When this happens there is a risk of the artery rupturing or leaking.
A ruptured aortic aneurysm is often fatal.
Most aortic aneurysms occur in the section of aorta that passes through the abdomen, and are called abdominal aortic aneurysms.
Many smaller aneurysms never require surgery. With larger aneurysms an operation is considered if the risk of the aneurysm rupturing is greater than the risk of surgery.
How are they detected?
Aneurysms can go undetected for many years; occasionally they may be detected during medical tests for an unrelated problem, for example during an examination, x-ray or CT scan.
The Gloucestershire aneurysm screening programme was set up in 1990 to detect asymptomatic aortic aneurysms. All male patients of participating GP surgeries are invited as they reach the age of 65 for an ultrasound scan.
Any patients found to have a 4cm or greater aortic diameter are referred to a consultant vascular surgeon for discussion and possibly further investigations.
Aortic aneurysms usually cause no symptoms. Occasionally they may cause back or abdominal pain in which case urgent medical attenion should be sought.
Risks of surgery
Repair of an abdominal aortic aneurysm is a major operation. The operation and anaesthetic puts a strain on the vital organs and there is a risk of heart failure, chest infection, infection of the graft or wound, kidney damage or thrombosis (blood clot).
The overall chance of not surviving the operation is 5 - 10%. This can depend on your overall fitness and will be fully discussed with you.
Disturbance to sexual activity is common after aneurysm surgery. If this is of concern to you please discuss this further with your surgeon.
The information contained on this website is intended as a guide only, it is not intended to subtitute for medical consultation.
For further information please see your doctor.
Who is at risk?
||aortic aneurysms are more common in men than women and often over the age of 60
||people with a history of arterial disease
||more common in families with a history of aneurysm disease
||people with a history of smoking
What are the treatment options?
Open surgery has been the national standard for abdominal aortic aneurysm repair for more that 50 years. Recent advances in minimally invasive surgery and surgical equipment has seen new treatment options being developed for aortic disease.
The surgery is carried out through a large cut made in the abdomen. The aneurysm is opened and a synthetic graft (tube) is sewn in to replace the weakened area of the aorta. The blood flow is then re-established.
Endo Vascular Repair (EVAR)
This is carried out by making a cut in the groin area, a stent graft is inserted in collapsed form and opened inside the aneurysm under x-ray guidance. The synthetic graft (tube) is hed in place with a stent. This procedure is carried out by a vascular surgeon and a vascular radiologist working together. Patients who have an aneurysm repair carried out by EVAR will have to regular check ups for the rest of their lives. Regular CT are will be required to check the position of the stent graft and to look for an endoleak. An endoleak is where blood leaks into the area between the stent and the aorta. This may require further surgery.
Nice has produced further information that you may find useful.
Laparoscopic Aortic Aneurysm Surgery
Laparoscopic or "keyhole" aortic aneurysm surgery is carried out by making very small cuts in the patientís abdomen, a fine telescope (a laparoscope) and other instruments are inserted through these cuts.
Using these instruments the surgeon performs the aortic aneurysm repair without making a large cut in the abdomen. As with open surgery the synthetic graft (tube) is sewn in place to replace the weakend area of the aorta.
Further information on laparoscopic aortic surgery can be found here.