An aneurysm is a pathological dilation of a blood vessel. Aneurysms most frequently occur in arteries and in the area of the aorta. The main cause of aortic aneurysms is arteriosclerosis, i.e. calcification of the vessel wall. Men over the age of 65 are most frequently affected. However, younger people can also suffer from an aortic aneurysm, which is often genetic (i.e. congenital).
Below you will find further information on aneurysms and specialists for aneurysm surgery.
An aneurysm is the abnormal dilation of an artery. This has a negative effect on the blood flow because turbulence can occur. In addition, a tear can occur in the dilated and often weakened arterial wall.
Aneurysms can occur as follows:
The following video shows how an aneurysm of the aorta develops:
The risk of the artery bursting (rupture of the aneurysm) increases from a certain diameter of the enlargement. If the aneurysm bursts forwards (into the free abdominal cavity), the patient bleeds to death within a few seconds.
Only if the aneurysm ruptures backwards (towards the spine) can doctors stop the bleeding. The patient can reach the hospital alive. Survival is only possible with immediate surgery, but even here the chances are very poor.
Many aneurysms go unnoticed; doctors then speak of asymptomatic aneurysms (i.e. without symptoms). This is why doctors only discover aneurysms by chance. Usually during routine examinations or when a patient is being examined by a doctor because of other complaints.
Aneurysms with symptoms (symptomatic abdominal aortic aneurysms) are characterized by back or flank pain.
An aortic aneurysm rupture is often indicated by
The loss of blood leads to circulatory failure.
An aortic aneurysm is a sac-shaped enlargement in the vessel walls of the aorta @ Oleksandr Pokusai /AdobeStock
The aim of all treatment measures is to prevent a rupture and death from bleeding. Ideally, this can be achieved without surgery.
Consistent control and treatment of elevated blood pressure levels are important here. However, stopping cigarette consumption and losing weight can also prevent the bulge from increasing in size.
Up to a maximum diameter of 5.5 cm (5 cm in women), this conservative approach (i.e. without surgery) is justified.
However,regular sonography examinations are essential and are usually carried out every 3 to 6 months.
An abdominal aortic aneurysm operation is often a preventive measure to stop the disease from progressing. Also to prevent an aneurysm rupture.
In the event of an aneurysm rupture - as already described - the chances of survival are very poor. It is therefore important to prevent it.
The risk of rupture increases exponentially with increasing vessel diameter. The risk of rupture in aortic aneurysms with a transverse diameter of < 5.5 cm is less than 3 percent per year.
Therefore, surgery should be performed on an aneurysm with a transverse diameter of 5.5 cm or more (5 cm for women).
However, as every surgical procedure has risks, doctors should carefully weigh up the benefits and risks.
Serious (even fatal) complications can occur in around 3 to 5 percent of elective (planned) abdominal aortic operations.
Doctors therefore recommend a conservative approach for aneurysms < 5.5 cm. For aneurysms > 5.5 cm, the risk of a fatal rupture is greater than the risk of complications during and after the operation.
A further indication for surgery is a rapid increase in the size of the abdominal aortic aneurysm (> 10 mm per year) and signs of rupture. If a rupture is present, surgery must be performed immediately.
Comparison of normal aorta and aortic aneurysm @ Alila Medical Media /AdobeStock
The decision as to whether an operation should be performed also depends on other factors. The patient's wishes are particularly important when planning treatment. It is quite possible that a patient will refuse surgery. Even with the knowledge that a rupture could lead to death from bleeding.
Albert Einstein also suffered from an aortic aneurysm. He refused surgery and ultimately died from an aneurysm rupture.
Age and the number of previous illnesses also play a role in treatment planning and the choice of procedure.
Open surgery of the aortic aneurysm is associated with an increased complication rate in this patient group. Endovascular aneurysm removal (minimally invasive procedure) may be an alternative. Surgery for an abdominal aortic aneurysm is never without risk.
During open aneurysm surgery, doctors expose the aneurysm via an abdominal incision, clamp it and open it up.
They then peel out the bulge and sew in a plastic tube. They remove the diseased artery wall, so to speak, and replace it with a strong plastic prosthesis. This reduces the risk of rupture.
In minimally invasive (endovascular) treatment, doctors push a prosthesis through the groin arteries into the aneurysm. This is done using X-rays.
The prosthesis is located in a sheath about the thickness of a ballpoint pen, which doctors can pull back via the inguinal artery. The prosthesis consists of a metal frame that expands by itself.
It anchors itself in the aortic wall after the sheath is retracted. It thus bridges the bulge. Even if the aneurysm subsequently bursts, there is less risk of death from bleeding.
The advantage of open surgery is that, as a rule, no follow-up examinations are necessary. Only in very rare cases does the vessel wall in the area of the sutures bulge out again.
With minimally invasive therapy, however, the prosthesis may be displaced more frequently. This is because the prosthesis is attached to the vessel wall from the inside and is not sutured in place.
For this reason, regular check-ups are necessary, which are carried out using computer tomography or ultrasound.
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