Depending on the location of the outpouching, the following undesirable side effects of aortic aneurysms are known: Complications that can be explained by mechanical pressure on surrounding structures, such as hoarseness due to damage to laryngeal nerves, difficulty swallowing, and shortness of breath. However, the growing aneurysm can also severely impair blood flow to other organs or to the arms and legs. If blood clots form in the distended aneurysm sacs, they can also be the starting point for embolisms, for example into the brain, and thus for strokes. The most serious complication of all aneurysm forms is certainly when the aneurysm bursts. This emergency situation is survived by the patient in very few cases.
Treatment of aortic aneurysm
The following treatment options are available for aortic aneurysm:
- Drug therapy for hypertension
- Open surgery
- Insertion of a vascular prosthesis from the groin (endovascular surgery).
Drug therapy for aortic aneurysm.
If risk factors such as high blood pressure, dyslipidemia or obesity can be controlled by medication or other measures, the aortic aneurysm can not be cured, but the course of the disease can be favorably influenced in most cases. The treatment here is aimed primarily at preventing the critical enlargement of the aneurysm to more than 5 to 6 cm in diameter and thus reducing the likelihood that the aneurysm will burst.
Open surgery for aortic aneurysm
Two surgical procedures are available to treat aortic aneurysm. In the so-called open vascular surgery, the abdominal aorta is exposed and the part with the aortic aneurysm is replaced with a vascular prosthesis – consisting of a plastic tube. Although this operation is very stressful for the patient, it offers a safe curability, so that further controls are not necessary. Since emergency surgery for a ruptured aortic aneurysm is successful in very few cases, the attending physician’s primary task after diagnosis of an aortic aneurysm is to monitor the development of the aneurysm through regular follow-up examinations and to determine the right time for surgery. In each individual case, the risk of the operation itself must be weighed against the risk of not operating and thus accepting a possible rupture of the aortic aneurysm – especially in older patients with additional heart or lung diseases.
Endovascular surgery for aortic aneurysm.
An alternative method of treatment, which does not require opening the abdominal wall and thus places a much lesser burden on the patient, has become established over the past few years. In this procedure, a vascular prosthesis (stent prosthesis) is inserted into the vascular system via the inguinal artery while the patient is awake, thereby lining and stabilizing the area of the aneurysm from the inside. A disadvantage of this form of treatment, however, is the need for lifelong regular monitoring. In addition, several follow-up interventions may be necessary, as the stents do not last indefinitely and may leak over time. Not every patient and not every aneurysm is a candidate for this procedure. However, in patients who cannot undergo surgery because of age or other conditions, insertion of the vascular prosthesis is often the only treatment option available.
Preventive measures
For the prevention of aortic aneurysms, essentially all measures by which vascular disease can be prevented or at least favorably influenced in its course are suitable. These include weight management for obesity, smoking cessation, effective treatment of hypertension or diabetes, dietary measures for dyslipidemia or gout, reduction of psychological stress factors, and regular physical exercise. Unfortunately, genetic factors as the cause of aortic aneurysms cannot be influenced today either by medical treatment measures or by personal behavioral rules. Since January 2018, men aged 65 and older with statutory health insurance have been entitled to a one-time screening examination for the early detection of aneurysms of the abdominal aorta. This is because this group has a particularly high risk of aortic aneurysms.During the examination, the doctor performs an ultrasound of the abdomen, which allows him to measure the thickness of the abdominal aorta and thus detect any possible change in the aorta.
