Blood pressure in the arteries, along with atherosclerotic processes that affect it, leads over time to the destruction of the supporting layers of the blood vessels, causing them to dilate and, without appropriate treatment, to rupture. Rupture leads to internal bleeding and puts the patient's life in danger.
The dilation of the aneurysm can be reduced by lifestyle changes (smoking cessation, low-cholesterol diet, etc.), but in most cases, surgical intervention is also required. The choice of the most suitable surgical approach for repairing an aneurysm depends on several factors, including the location and shape of the aneurysm and the general physical condition of the patient.
During the surgery, a catheter-based approach is used to introduce an endovascular stent-graft into the aneurysm area to stabilize the weakened area. The stent is a supported tube made of a metal wire mesh that reinforces the structure of the blood vessel. The stent allows blood to pass through without exerting pressure on the aneurysm.
The main goal of the surgical treatment is to reduce the risk of complications that can result from the aneurysm in the arteries. The primary risk of an untreated aneurysm is a sudden rupture, and the risk of rupture increases as the aneurysm grows larger. The decision to treat the aneurysm is determined by various factors, including the appearance of symptoms such as abdominal pain, back pain, groin pain, or inner thigh pain, the size and diameter of the aneurysm, the rapid expansion of the aneurysm, sudden separation of the artery walls, and the general medical condition of the patient, among others.
The traditional surgical method involves making a long incision along the chest or abdomen (depending on the location of the aneurysm). After the incision is made, the arteries surrounding the aneurysm are temporarily blocked, and then the aneurysm is opened and the endovascular stent-graft is inserted into it. The stent is sewn to the arteries above and below the aneurysm. Finally, the artery is closed above the stent.
Alternatively, endovascular repair can be done using catheters – thin, long tubes that are inserted through the groin arteries to deliver the stent-graft to the aneurysm area. The catheterization is guided by X-ray fluoroscopy to precisely position the stent. The stent is expanded within the artery using a balloon and fixed in place using built-in metal wires without sutures. The catheterization is usually done under local or general anesthesia, depending on the patient's and the medical team's choice.
After the traditional surgery, the patient will likely need a minimal hospital stay of five to ten days, while after endovascular repair, the hospitalization is usually one to two days. Full recovery can take between four to six weeks.
As with any surgical procedure, there are potential risks and complications associated with both approaches. Complications can include problems related to the heart, blood clots or infections at the surgical site, respiratory or urinary tract infections, and more severe problems like issues with the large intestine or kidneys. However, these severe complications are rare.
The patient will receive specific post-operative instructions after the surgery, and there might be some discomfort and tiredness for a few weeks. Appetite may be reduced for a while, and some patients may lose up to 10 kg during the recovery period. Strenuous activities should be avoided for a certain time, and the patient is encouraged to stay active and walk as much as possible after the surgery.
Both surgical methods usually yield excellent results, and most patients return to normal life as if they never experienced an aneurysm. However, patients, even after successful surgical repair, remain at an increased risk of heart and vascular diseases and need to adopt a healthy lifestyle, including a proper diet and physical activity, to manage this risk effectively. The risk assessment for these diseases is done based on the patient's history and the surgical procedure they underwent.