Aortic Aneurysms Medical treatment

Medical therapy  of aortic aneurysms involves strict blood pressure control. This does not treat the aortic aneurysm per se, but control  of hypertension within tight blood pressure parameters may decrease  the rate of expansion of the aneurysm. 

Surgical treatment

The definitive  treatment for an aortic aneurysm is surgical repair  of the aorta. This typically involves opening up  of the dilated portion of the aorta  and insertion of a synthetic (Dacron or Gore-tex) patch tube. Once  the tube  is sewn into the proximal  and distal portions  of the aorta, the aneurysmal sac is closed around  the artificial tube. Instead  of sewing, the tube ends, made rigid and expandable by nitinol wireframe,  can be much more simply and quickly inserted into the vascular stumps and  there permanently fixed  by external ligature.

The determination of when surgery should be performed  is complex  and case-specific. The overriding consideration is when  the risk of rupture exceeds the risk of surgery. The diameter of  the aneurysm, its rate of growth, the presence  or absence  of Marfan Syndrome or similar connective tissue disorders, and other coexisting medical conditions are all important factors in the determination. 

A rapidly expanding aneurysm  should be operated on  as soon as feasible, since it has a greater chance  of rupture. Slowly expanding aortic aneurysms may be followed by routine diagnostic testing (ie: CT scan  or ultrasound imaging). If the aortic aneurysm grows at a rate of more than 1 cm/year, surgical treatment should be electively performed. 

The current treatment guidelines  for abdominal aortic aneurysms suggest elective surgical repair when the diameter of  the aneurysm is greater than 5 cm. However, recent data suggest medical management for abdominal aneurysms  with a diameter  of less  than 5.5 cm.

Endovascular treatment  of AAA 

In the recent years, the endoluminal treatment of Abdominal Aortic Aneurysms has emerged as  a minimally invasive alternative  to open  surgery repair. The  first endoluminal exclusion of  an aneurysm took place  in Argentina by Dr. Parodi and his colleagues in 1991. The endovascular treatment of aortic aneurysms involves  the placement of an endo-vascular stent via a percutaneous technique (usually through  the femoral arteries) into  the diseased portion of  the aorta. This technique has been reported to have  a lower mortality rate compared  to open surgical repair, and is now being widely used in individuals with co-morbid conditions that make them high risk patients for open surgery. Some centers also report very promising results for  the specific method  in patients that do not constitute  a high surgical risk group. 

There have also been many reports concerning  the endovascular treatment of ruptured Abdominal Aortic Aneurysms, which are usually treated with an open surgery repair due to  the patient's impaired overall condition. Mid-term results have been quite promising. However, according  to the latest studies,  the EVAR procedure doesn't carry any overall survival benefit.

Endovascular treatment of other  aortic aneurysms

The endoluminal exclusion  of aortic  aneurysms has seen  a real revolution in the very recent years. It  is now possible  to treat thoracic aortic  aneurysms, abdominal aortic  aneurysms and other  aneurysms in most  of the body's major arteries (such as  the iliac and the femoral arteries) using endovascular stents  and avoiding big incisions. Still,  in most cases  the technique  is applied  in patients at high risk for surgery as more trials are required  in order to fully accept this method as the gold standard for  the treatment of aneurysms.