Aortic aneurysm treatments improve
DEAR DOCTOR: I was recently diagnosed with an aortic thoracic aneurysm and scheduled for surgery. Can I expect to live a normal life afterward?
DEAR READER: An aortic aneurysm is a bulging area within the aorta — the body’s main artery — through which the heart pumps blood to the rest of the body. The aorta starts in the chest, called the thoracic region, and then runs down into the abdomen. The problem with these bulges is that they can lead to rupture of the aorta, causing major blood loss and possible death.
People with thoracic aneurysms are usually unaware of the aneurysm until it is about to rupture; most are found through imaging studies looking for something else. The decision on whether to have surgery is based on the size of the aneurysm, whether the aneurysm is growing rapidly and whether it’s causing symptoms. Survival rates are much higher for aneurysms that don’t cause symptoms. So the ability to schedule surgery is a positive sign.
The type of surgery depends on the location of the aneurysm. Those closer to the heart are more likely to require an open surgical procedure — specifically, a median sternotomy. In this surgery, the sternum (breast bone) is cut up the middle to open up the chest, and blood must be bypassed away from the heart and into a machine that pushes it through the body. The diseased section of the aorta is then removed and replaced with an artificial graft.
For aneurysms farther from the heart, an endovascular repair can suffice. With this operation, there is no need to open up the chest. A doctor inserts a graft through an artery in the upper thigh and places it inside the vessel. The graft works like a stent, allowing blood to flow through it without putting pressure on the aneurysm.
Although the open procedure has a greater risk of complications, the overall survival rate is similar for both procedures. But surgical techniques for both procedures are improving all the time, increasing the likelihood of a return to normal life.