What is an aneurysm?
Blood vessels, particularly arteries, can develop aneurysms. This involves destruction and weakening of the vessel wall so that it dilates (expands) to become larger than normal. In advanced cases aneurysms can rupture and patients can bleed internally. The vessel most affected is the aorta, the main artery that carries blood from the chest, through the abdomen and down to the legs. A ruptured aortic aneurysm is a life-threatening event that usually has a catastrophic outcome. Aneurysms can also occur in the legs and elsewhere.
Who can get an aneurysm?
Men over 65 years old are most at risk although women and younger people can also develop an aneurysm. People who have relatives with aneurysm, have high blood pressure or cholesterol, and who have smoked are also at increased risk of aneurysm. Aneurysms are four times more common amongst smokers than non-smokers and people with aneurysm who smoke should consider stopping. Once the aortic wall is damaged it will usually continue to increase in size over time.
How will I know if I have an aneurysm?
Most aortic aneurysms cause no symptoms and are discovered incidentally by examination or on X-rays however some people may get pain from their aneurysm. Severe pain and collapse occurs when an aneurysm ruptures. This is an emergency and most people don’t survive. Aneurysms can also develop blood clots which can move to the legs and compromise the circulation. For these reasons when aneurysms are detected consideration needs to be given to repairing them to prevent these problems.
How can I find out if I have an aneurysm?
Ultrasound is the best way to detect an aneurysm in order to be able to repair it before it ruptures. Elderly men who have smoked should consider having an ultrasound and anyone with a family history should discuss this option with their GP or Specialist. An ultrasound will provide an accurate assessment of the size of the aneurysm and the risk of rupture. Computed tomography (CT) is the best test to examine an aneurysm before repairing it.
Should I have my aneurysm repaired?
As aneurysms get bigger the risk of rupture increases. When the risk of rupture is greater than the risks associated with repairing an aneurysm then patients should consider having their aneurysm repaired. This typically is the case when the aneurysm is greater than 5 cm in diameter as approximately 10% will rupture each year. It does however also depend on how your health is otherwise, particularly if you also have heart or lung problems. Painful aneurysms should ideally be repaired as they have the greatest risk of rupture.
What if my aneurysm is small?
If you smoke, then you should consider quitting. You should also see your GP to make sure your blood pressure and cholesterol are under control. Unfortunately, there are no drugs that will stop an aneurysm from growing. You should also discuss with relatives whether they need to be checked for an aneurysm particularly if there is a family history. You should have ultrasound surveillance performed by an experienced vascular sonographer to monitor growth, either each year or every six months depending on the size of the aneurysm.
How is an aneurysm repaired?
There are two methods to repair an aneurysm to prevent it from rupturing. In the past all aneurysms were repaired by open surgery through a large incision in the abdomen. These days most aneurysms can be repaired using minimally invasive keyhole surgery through the groins. This is called endovascular aneurysm repair (EVAR). Stents are used to reline the aorta and protect the aortic wall from rupturing. Endovascular aneurysm repair is effective and safe in selected patients with fewer risks than open surgery. It is still however a major operation done under general anaesthesia in hospital. Patients need to have their health optimised before proceeding with any aortic procedure.
What are the risks of surgery?
As with any surgery there comes risks, infection and blood clots can occur. Patients will receive medication to help prevent these complications. Additional stress placed on the heart can trigger a heart attack particularly in patients with existing heart conditions. Damage can also occur to the kidneys, the groin arteries used to access the aneurysm or a leak can develop around the stent used to repair the aneurysm however it is rare that patients do not survive the procedure due to complications.
What happens after I have had my aneurysm repaired?
Patients can expect to spend a few days in hospital following surgery and you will need to have a CT scan to confirm a successful repair. In rare cases, over time the stents can move, or a leak may develop. For this reason, patients should continue to follow up with their surgeon as an ultrasound can usually detect these problems. It is generally accepted that regular surveillance after endovascular aneurysm repair should be lifelong.
Sydney Vascular Ultrasound provides specialised vascular and venous diagnostic imaging in Burwood, Bankstown and Liverpool.