What is an aneurysm?

An aneurysm is a weakened area of an artery that bulges or expands. The greatest concern with an aneurysm is that it may rupture. Aneurysms that rupture can cause severe internal bleeding, which can be fatal. Heart and vascular specialists at The Ohio State University Wexner Medical Center are experienced in performing various types of aneurysm repair procedures, right here in Columbus.

What is an aortic aneurysm?

An aortic aneurysm is a bulge or weak spot in the aorta, one of the large arteries through which blood passes from the heart to the rest of the body. Aneurysms in the aorta occur primarily in two places: 

• An abdominal aortic aneurysm occurs in the part of the aorta that passes through the middle to lower abdomen. 
• A thoracic aortic aneurysm occurs on the aorta as it passes through the chest cavity. These are less common than abdominal aortic aneurysms.

Aneurysm symptoms and diagnosis

Aneurysms often don’t cause symptoms, and your doctor may find it accidentally during an examination for another condition, such as via an ultrasound or CT scan. Your doctor may recommend emergency surgery if the aneurysm causes symptoms, such as abdominal or back pain, or because the aneurysm may be on the verge of bursting.

Aneurysm treatments

There are two types of aneurysm repair surgeries. An aneurysm can be repaired with an endovascular stent graft or with open surgical repair. The best method to repair each aneurysm depends on factors such as the location and size of the aneurysm, as well as your overall health. You and your surgeon will determine which procedure is right for your condition.

• Endovascular repair: An endovascular stent graft is a woven fabric tube wrapped around a metal stent, which is a mesh-like tube of thin wire. In endovascular repair, your surgeon uses a catheter (thin tube) to guide the stent graft through small incisions in the groin to the place of the aneurysm. The surgeon inserts the graft into the aneurysm and seals the aneurysm from within to keep it from rupturing. This procedure can eliminate the need for open surgical repair. 
• Open surgical repair: In open surgical repair, your surgeon makes an incision in the abdomen or chest, then removes the damaged area and replaces it with a stent graft. Your heart specialist may recommend open surgical repair if the aneurysm anatomy does not allow for endovascular repair. 
• Watchful waiting: Heart and vascular specialists can monitor or surgically correct an aneurysm while the bulge is intact but must perform emergency surgery if it ruptures. If your aneurysm is small, your physician may recommend watching and waiting, which means that you’ll be monitored every six to 12 months for signs of changes in the aneurysm size. Physicians and patients must discuss and decide if the risk of surgery is less than the risk of possible bleeding if an aneurysm isn’t repaired.

A ruptured aneurysm is a very dangerous condition. Although it is possible to repair a ruptured aneurysm surgically, it’s important to identify and treat aneurysms before a rupture occurs. An aneurysm that causes internal bleeding requires open surgery aneurysm repair.

What to expect during aneurysm repair surgery

Preparing for your procedure

Before surgery, you’ll meet with your physician to discuss your medical history, the medicines you take and any questions you have. Tell your doctor if you’re allergic to any medications or to IV dye or contrast. If you’re diabetic, you should discontinue glucophage or metformin. If you’re pregnant or if there’s any possibility that you’re pregnant, tell your doctor.

Your physician may also schedule routine tests. A vascular surgeon will give you instructions to follow before the surgery, such as fasting (avoiding eating or drinking).

During your procedure

Endovascular repair

Your anesthesiologist will inject a general anesthetic through an intravenous line inserted prior to the procedure, so you’ll be fully asleep during the stent placement. Your nurse or other member of the surgical team will shave and clean the area of catheter insertion.

To begin this procedure, your doctor will make a small skin incision in the area of your groin. The doctor will then insert a long thin wire into your femoral artery through the groin and guides it to the area of the aneurysm. Using X-ray and contrast dye for guidance, your doctor threads a catheter over the wire. The doctor inserts another large catheter called a sheath. The sheath contains the graft stent that the doctor will place at the site of the aneurysm. When the graft reaches the aneurysm site, the doctor withdraws the sheath, and the graft expands and stays in place.

Open surgery repair  

During this procedure, the surgeon makes an incision in the skin in the area above the aneurysm. Once your surgeon locates the aneurysm, the surgeon places clamps on it, below and above the bulge. The surgeon cuts open the aneurysm and attaches an artificial graft to the sides of the artery. This tube connects the artery above and below the aneurysm. After the surgeon wraps the wall of the aneurysm around the graft, he or she removes the clamps to allow blood to flow.

After your procedure

You may be connected to the following equipment after surgery: 

• A heart monitor 
• A tube in the nose that delivers oxygen and an oxygen monitor on your finger 
• A Foley catheter, a tube that goes into the bladder to drain urine 
• An intravenous line (IV) to provide fluids

Soon after the procedure is complete, your surgical team will move you to a recovery room where your nurse will remove your IV line. Your nurse will monitor your catheter site for a period of time for bleeding and swelling. Your nurse will also monitor your heart rate.

Endovascular repair 

You’ll spend a couple of days in the hospital, during which time you’ll get up and walk around. You’ll be able to eat normally. Your doctor will monitor your stent graft periodically with imaging tests to be sure the stent is functioning.

Open surgery repair 

Your physician may schedule you for an imaging study to make sure that your aneurysm isn’t redeveloping and that the graft is functioning properly.

You’ll likely stay in the hospital for seven to 10 days after your surgery, depending on the site of your incision and your general health. Your physician or vascular surgeon will give you any special instructions you need to follow after the surgery.