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Aortic Aneurysm Surgery


An aneurysm is an out-pouching or balloon-like bulge of a portion of a blood vessel that can occur in an artery anywhere in the body.  Aorta is the largest blood vessel in the body. When aneurysm occurs, it can be thoracic aneurysm near the heart or an abdominal aneurysm in the lower portion of the aorta. All aneurysm are not life threatening. But if a blood vessel wall bulges, it becomes thin and tense and at certain size that bulged portion of the vessel wall can rupture or tear off, causing a person to bleed to death. An aneurysm that bleeds into the brain can lead to stroke or even death. Some of the causes of the aortic aneurysm that weakens the wall of the blood vessel may include:
·        Atherosclerosis
·        Chronic  or untreated high blood pressure
·        Excessive smoking
·        Trauma
·        Congenital abnormality
·        Age factor
·        Heart or peripheral vascular disease
 
Large aneurysms cause symptoms such as chest or back pain, fatigue, tiredness, discolored skin, sores on feet and toes, palpitations, dizziness or shortness of breath etc. when aneurysm ruptures or tears, it can cause severe or unbearable pain in the back.
 
Doctor will consider few factors before recommending any treatment for aneurysm such as:
·        If the aneurysm can be repaired immediately or not.
·        If repair is the possible option depending on shape, size and rate of its growth.
·         Whether the patient will be able to withstand a surgery or procedure.
 
People who might have significant risk from surgery can have a less invasive repair procedure.  A surgery is recommended to remove the dilated portion of the vessel and replace it with a graft, or synthetic tube to prevent aortic aneurysm from rupturing or tearing.
 
Doctor will recommend “watchful waiting” when a thoracic aneurysm is small and doesn’t cause any symptoms. During this waiting period aneurysm will be monitored closely with CT scan or MRI scans every 6 months, medications will be given to control the high blood pressure and to decrease the pressure on the weakened part of the aneurysm, patient will be advised to restrict some physical activities such as heavy weight lifting to avoid the increased pressure on the aorta that can cause rupturing of the aorta. 
 
Large aneurysms can be diagnosed through x-rays such as CT scan, MRI scan, ultrasound or echocardiography to determine the exact location and size of the aneurysm. Sometimes, pulmonary function testing with a spirometer is also done to measure lung function.
 
Surgery for repairing aorta aneurysm can be performed in different procedures:
 
1.     Endovascular repair – vascular surgeon will make a small incision in the groin area to insert a sleeve on the inside of the aorta and advance the sleeve to the aneurysm.  This sleeve will prevent the wall from expanding or leaking by taking off the pressure off the wall. In this procedure, recovery is quicker and easier hence making it more preferred option by the patients.  But in most of the cases, doctor has to performed open surgery as the available sleeves are often incompatible with patient’s body. 
2.     Open surgery –During the open surgery method, patient will be given general anesthesia to make him/her fall asleep.  Surgeon will make an incision along the left side of the chest and spread apart the ribs and replace the weakened area of the aorta with an artificial blood vessel known as synthetic graft. While sewing the graft in place, blood flow through the aorta must be stopped and blood circulation to the body is often maintained using pumps while the aorta is clamped. 
 
Patient may require staying in the hospital for a week and will be given medicines to control any fluid buildup, blood clotting or pain after the surgery.  It is recommended to maintain healthy lifestyle, healthy food habits, exercising to get the strength, quitting smoking, or maintain a healthy weight. It may take 4 weeks to go back to the desk job but in case, patient have more physically demanding job then he/she may require 6 to 8 weeks or even more.
 
Some risks and complications associated with open surgery may include:
·        Heart attack
·        Unexpected bleeding during or after surgery
·        Blood clots
·        Loss of blood flow to legs
·        Injury to the bowel
·        Irregular heart rhythms
·        Infection in wound
·        Lung problems
·        Kidney damage
Injury to spinal cord 

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