An aortic aneurysm occurs when part of the aortic wall becomes abnormally dilated.
Aneurysms often cause no symptoms and are found by chance during an imaging test carried out for another reason. Some aneurysms can grow over time and, depending on their characteristics, lead to serious complications.
For this reason, when an aneurysm is detected it is important for it to be monitored by a specialist and to assess individually whether it needs treatment.
At Berkelium Surgical Group we study each case to understand the characteristics of the aneurysm and determine the most suitable strategy: monitoring, endovascular treatment, open surgery or complex endovascular techniques.
What causes an aortic aneurysm?
Several factors are related to the development and progression of aneurysms:
- Age
- Smoking
- High blood pressure
- Atherosclerosis
- Family history of aneurysm
- Male sex
- Some inherited connective tissue disorders
- History of certain diseases or injuries of the aorta
Not all aneurysms behave in the same way. That is why, in addition to size, it is important to assess their location, shape, growth rate and the patient’s general characteristics.
Abdominal aortic aneurysm
This is one of the most common types and affects the segment of the aorta that runs through the abdomen. Many abdominal aneurysms cause no symptoms and are detected by chance.
When they do cause symptoms, these may include:
- Persistent abdominal pain
- Lower back pain
- A feeling of pressure or discomfort in the abdomen
- A pulsating sensation in the abdomen
The risk associated with an aneurysm depends, among other factors, on its size, progression and characteristics.
Thoracic aortic aneurysm
An aneurysm can also be located in the chest.
It can affect different segments of the aorta, and treatment depends on its exact location and characteristics.
As with abdominal aneurysms, some can remain symptom-free for a long time.
When symptoms do appear, they may include:
- Chest pain
- Back pain
- Shortness of breath
- Cough or discomfort caused by pressure on nearby structures
Aorto-iliac aneurysms
In some people the dilation is not limited to the abdominal aorta but also affects the iliac arteries, which continue from the aorta towards the pelvis and legs.
Treatment can be particularly complex because blood flow must be preserved to different territories, including the limbs and, in certain circumstances, the arteries that supply the pelvis.
Aortic dissection
This occurs when a tear in one of the layers of the aortic wall creates a double channel within the aorta.
It can occur suddenly and cause serious symptoms, so it requires urgent medical assessment.
One of the most characteristic symptoms is sudden, severe pain in the chest or back.
Treatment depends mainly on the location of the dissection and whether there are complications.
How are they diagnosed?
Aneurysms are diagnosed and monitored with different imaging tests.
Ultrasound: Abdominal ultrasound can be used to detect and monitor certain abdominal aortic aneurysms. It is a simple, non-invasive test that does not use radiation.
CT angiography: This provides detailed images of the aorta and its branches. It is especially important when planning an intervention, as it shows:
- Size of the aneurysm
- Location
- Length
- Anatomy of the arteries
- Relationship with the arterial branches
- Characteristics of the areas where a stent graft must be anchored
Magnetic resonance imaging: In certain patients it can be used to study and monitor the aorta, depending on the characteristics of each case.
When does an aneurysm need treatment?
In some patients, regular monitoring with imaging tests and control of cardiovascular risk factors is recommended.
The decision to repair an aneurysm depends on the following characteristics:
- Anatomy of the aorta and its branches
- Size, shape, location and growth rate
- Patient factors: age, general health, medical history and life expectancy
- Symptoms
All of this determines the risk of surgery, which in turn guides whether intervention is indicated. That is why the size of the aneurysm is important, but it is not the only criterion that determines the need for treatment.
Surgical techniques
Open aortic surgery
In this technique the aorta is accessed directly to replace the affected segment with a prosthesis or vascular graft, allowing blood to flow through a new channel and preventing blood pressure from acting on the weakened wall of the aneurysm.
It is a more complex procedure than endovascular repair and requires a careful assessment of the patient’s general health.
Despite the development of endovascular techniques, open surgery still plays an important role in certain patients, especially when the anatomy does not allow a suitable endovascular repair or when the patient’s characteristics and life expectancy make it an appropriate option.
Endovascular aneurysm repair
EVAR (EndoVascular Aneurysm Repair): endovascular repair of an abdominal aortic aneurysm.
This is a minimally invasive technique in which a stent graft is introduced through the arteries, usually from the groin.
The stent graft is placed inside the aorta and allows blood to flow through the device, reducing the pressure on the aneurysm wall.
For this procedure to be considered, the anatomy of the aorta and the access arteries must be suitable for correctly placing and anchoring the stent graft.
TEVAR (Thoracic Endovascular Aortic Repair) is used to treat diseases of the thoracic aorta. In these cases it offers a less invasive alternative to open surgery, which is very important in this territory.
Not all aneurysms have a simple anatomy. In some patients the aneurysm affects areas close to the arteries that supply vital organs, or extends across different segments of the aorta. These cases require more advanced planning and may need complex endovascular techniques.
Options include different types of stent grafts designed to adapt to complex anatomy, including fenestrated (FEVAR) or branched (BEVAR) devices in selected patients.
Endovascular treatment can offer certain advantages over open surgery, such as less surgical trauma and a generally faster initial recovery. However, follow-up after endovascular repair requires closer monitoring with imaging tests. The decision always depends on the case and is tailored to offer the patient the best possible technique.
For this reason, before choosing between open surgery and endovascular treatment it is important to weigh both the immediate benefits and the long-term follow-up needs.
When should you see a vascular surgeon?
If you have been diagnosed with an aortic aneurysm, it is important to have a specialist assessment even if you have no symptoms. It is also advisable to seek advice if you have a family history of aneurysm or risk factors associated with vascular disease.
Being diagnosed with an aneurysm can raise many questions.
- Do I need an operation?
- Can I wait?
- Is open surgery or endovascular treatment better?
- Will I be able to lead a normal life?
- Will I need check-ups after treatment?
The answer depends on the specific characteristics of each aneurysm and each patient.
Our goal is to study each case in detail and offer the most suitable strategy, explaining to the patient the different alternatives, their benefits, their risks and the follow-up required.