There are basically two different ways to treat an aortic aneurysm. In the case of smaller aneurysms, it is better to wait and have regular ultrasound examinations. In addition, risk factors that favour an aneurysm or its rupture should be treated or avoided.
These include keeping the blood pressure in the normal range of about 120/80, in some cases also by medication to lower the blood pressure. Diabetes and lipometabolic disorders must also be treated. In the case of larger aneurysms in the abdominal cavity, either open surgery is available, in which the dilated piece of the aorta is removed and replaced by a prosthesis.
There is also the possibility of inserting a kind of stent via the artery in the groin and placing it in the place of the aneurysm. In this way, the blood no longer flows into the aneurysm, but rather past it via the stent. An open surgery is usually performed in the chest area.
If the aneurysm is close to the heart, the aortic valve may also need to be replaced. In the case of an aneurysm in the chest area, surgery should be performed from a size of 55 mm. If there is a disease of the connective tissue (e.g. Ehlers-Danlos syndrome or Marfan syndrome) the limit is 50 mm.
Surgery is also indicated in the event of rapid growth of more than 2 mm per year. An abdominal aortic aneurysm should be operated at a size of 60 mm. Further indications are a rapid increase in size of more than 0.5 cm in three months, symptoms caused by the aortic aneurysm and a high risk of rupture, e.g. in cases of poorly adjustable high blood pressure.
An aortic prosthesis is a tissue tube used in the treatment of aortic aneurysm. Above a certain size, surgery on the aneurysm should be performed, because the larger the diameter, the greater the risk of rupture. The prosthesis can be inserted in two ways.
On the one hand, during surgery the affected piece of the aorta is replaced by the prosthesis, on the other hand there is a minimally invasive method using a catheter. In this case, the prosthesis is folded up and advanced through a vessel to the affected area. Here it unfolds and thus removes the aneurysm from the bloodstream.
Complication: Rupture of the aneurysm
The rupture of an aortic aneurysm is a life-threatening complication. Once a sacculation of the vessel wall has formed, it usually continues to expand. The risk of a rupture is particularly high if the diameter is more than 55 mm in the chest area and more than 60 mm in the abdomen.
The bursting of the aneurysm leads to extremely severe pain in the abdomen or chest, often accompanied by nausea and vomiting. Internal bleeding occurs, in which the affected person can lose very large amounts of blood within a very short time. The result is circulatory shock and in most cases death.