Aneurysm surgery | Specialists and information

What is an aneurysm?

An aneurysm is a pathological, sac-like or spindle-shaped dilation of a blood vessel. It occurs particularly frequently in the aorta, the largest artery in the body. A distinction is made between abdominal aortic aneurysms (in the abdomen) and thoracic aortic aneurysms (in the chest).

Such dilations are usually caused by a weakness in the vessel wall - often caused by arteriosclerosis (vascular calcification). Genetic factors, high blood pressure or infections can also play a role. If an aneurysm is not treated in time, it can rupture, leading to internal bleeding and life-threatening complications.

The following video shows how an aortic aneurysm develops:

Symptoms: When should you think of an aneurysm?

Many aneurysms go unnoticed for a long time as they do not cause any symptoms. However, in the case of larger aneurysms or shortly before a rupture, the following symptoms may occur:

• Pain in the abdomen, back or chest area
• A palpable, pulsating tumor in the abdomen
• Difficulty breathing or swallowing (in the case of thoracic aneurysms)
• Circulatory problems or sudden drop in blood pressure

In these cases, immediate medical clarification is urgently required.

Diagnosis of an aneurysm

The diagnosis is usually made using imaging - usually by means of an ultrasound examination, CT angiography or MRI angiography. This allows the exact location, size and shape of the aneurysm to be determined. This information is essential for deciding on the necessity and type of aneurysm surgery.

An aortic aneurysm is a sac-shaped dilation in the vessel walls of the aorta @ Oleksandr Pokusai /AdobeStock

When is aneurysm surgery necessary?

Not every aneurysm needs to be operated on immediately. The most important factors are

• Size of the aneurysm: From a diameter of approx. 5.5 cm in the abdominal area, the risk of rupture increases significantly.
• Growth rate: Rapid growth in size is also a warning sign.
• Symptoms: Pain or other symptoms may indicate an impending rupture.
• General state of health: Risk factors and concomitant diseases are taken into account when deciding on surgery.

Comparison of normal aorta and aortic aneurysm @ Alila Medical Media /AdobeStock

What surgical methods are available?

There are two main methods available in modern vascular surgery:

1. classic open surgery

In this method, the aneurysm is exposed via an abdominal incision. The affected part of the aorta is removed and replaced with an artificial vascular prosthesis. This method is considered very safe, but is associated with a longer recovery time.

Advantages:

• Well suited for complex aneurysms
• Durable solution

Disadvantages:

• Higher blood loss
• Longer hospital stays
• Higher burden for elderly patients

2. Endovaskuläre Therapie (EVAR oder TEVAR)

Endovascular therapy is a minimally invasive treatment in which a vascular prosthesis (stent graft) is inserted via a small access in the groin. This method is particularly suitable for older or previously diseased patients.

Advantages:

• Less stressful for the body
• Shorter recovery time
• Lower risk of postoperative complications

Disadvantages:

• Regular follow-up care required
• Not possible for all aneurysm types

Endovascular therapy for an abdominal aortic aneurysm @ bilderzwerg /AdobeStock

How does an aneurysm operation work?

The exact procedure depends on the method chosen. In general, the procedure can be divided into the following phases:

1. Preparation: anesthesia, imaging, blood values, informative discussion
2. Procedure: Open surgery or stent implantation
3. Monitoring: After the operation, monitoring takes place in the intensive care unit or monitoring ward.
4. Rehabilitation: Depending on the patient's state of health, mobilization begins the next day or the day after.

Risks and complications

Like any operation, aneurysm surgery is also associated with risks. These include

• Bleeding
• infections
• Cardiovascular complications
• Renal dysfunction
• Endoleaks (in the case of stent implantation, i.e. leaks)

The choice of the appropriate surgical procedure by experienced vascular surgeons minimizes these risks considerably.

Aftercare and lifestyle after surgery

Regular follow-up care is crucial after aneurysm surgery. Annual check-ups are necessary, especially for endovascular procedures, to check the position and function of the stent.

Patients should also adjust their lifestyle:

• Treat high blood pressure consistently
• Abstain from nicotine consumption
• Healthy diet and exercise
• Control cholesterol and blood sugar

Prognosis: What are the chances of recovery?

Thanks to modern procedures, the chances of recovery are very good with timely diagnosis and treatment. Endovascular therapy has proven to be low-risk, especially in older patients. Open aneurysm surgery also shows excellent long-term results in younger or stable patients.

Conclusion: Aneurysm surgery - safety through modern medicine

Today, aneurysm surgery is a routine procedure in vascular surgery. Depending on the patient and the type of aneurysm, an individually suitable therapy is available - be it open surgery or minimally invasive endovascular procedures. Early diagnosis, an experienced specialist and consistent aftercare are crucial for successful treatment.

If you suspect you have an aneurysm or have already been diagnosed, you should not hesitate to contact a qualified specialist. The Leading Medicine Guide offers you an overview of renowned specialists for aneurysm surgery.