When is an Aneurysm Repair Surgery Needed?

An aneurysm is a medical condition in which the walls of the blood vessels are weakened and bulged out. It can develop anywhere in the body. But the most common and alarming ones occur in the aorta, the largest artery in the body.
Aortic aneurysms accounted for an estimated 150,000 to 200,000 deaths worldwide annually, underscoring the substantial public health burden they represent.
Aortic aneurysms are categorised into two types, Abdominal Aortic Aneurysm (AAA), affecting the aorta in the abdomen, and Thoracic Aortic Aneurysm (TAA), affecting the aorta in the chest.
Some common aneurysm symptoms and diagnosis methods are mentioned below to provide a clearer understanding of how this condition can be identified.
Common signs of Abdominal Aortic Aneurysm (AAA) include:
- Pulsating sensation in the abdomen
- Deep, constant abdominal pain
- Pain radiating to the legs or buttocks
Common symptoms of Thoracic Aortic Aneurysm (TAA) are:
- Chest or back pain
- Difficulty breathing or swallowing
- Cough or hoarseness due to pressure on nearby structures
Diagnosing aortic aneurysms includes imaging studies to confirm its presence, location, and size. Some standard diagnostic tools are ultrasound, CT Scan, MRI, angiography, and Transesophageal echocardiography (TEE).
Dr. Dinesh Kumar Mittal, a well-known cardiothoracic and vascular surgeon, advises, “Early detection of an aortic aneurysm can make all the difference between life and fatal complications. Regular health check-ups, especially for those with risk factors, are essential.“
The risk factors for developing aneurysms include high blood pressure and cholesterol, smoking, genetic factors, and age (with risks increasing with age).
What is an Aneurysm Repair Surgery?
Aneurysm repair surgery is a life-saving procedure to treat a weakened, bulging blood vessel and prevent it from rupturing. The surgery strengthens the blood vessel using a synthetic graft, either through EVAR or standard open surgery. It restores normal blood flow and reduces the risk of life-threatening complications.
When is an Aneurysm Repair Surgery Needed?
Aneurysm repair surgery is necessary when an aneurysm is at risk of rupture, which can lead to adverse complications or fatal bleeding. Repair surgery is needed when the aneurysm:
- Reaches a critical size (5- 5.5 cm or larger, depending on the location)
- Grows rapidly
- Causes pain or pressure on nearby structures
What are the Surgical Methods for Aneurysm Repair?
Following surgical methods are available, according to the type and location of the aneurysm.
Endovascular Aneurysm Repair (EVAR)
It is a minimally invasive aneurysm surgery in which a stent graft (a fabric covered metal tube) is inserted in the groin by making a small incision. The stent is placed at the aneurysm site using imaging technology to restrengthen the weakened blood vessel wall.
Open Aortic Aneurysm Repair
It is a standard surgical procedure in which a large incision is made in the abdomen or chest area to directly access the aorta. The surgeon removes the aneurysm and replaces the damaged section of the blood vessel with a synthetic graft.
Hybrid Aneurysm Repair Surgery
This combines open surgery and endovascular procedures. It is used for complex or thoracoabdominal aneurysms (aortic bulge running from the chest to the abdomen).
How to Prepare for Aneurysm Repair Surgery?
Preparation for aneurysm repair surgery is done in the following steps:
- Diagnostic tests to assess the aneurysm’s size, location, and risk.
- A physical examination following a review of the patient’s medical history.
- Pre-surgery instructions may include stopping some medications and smoking cessation.
- Managing chronic conditions like hypertension or diabetes to promote faster healing.
How is Open Aortic Aneurysm Repair Different from Endovascular Aneurysm Repair (EVAR)?
Open surgery is a preferred option for complex aneurysms, as it is durable and effective. It requires a longer recovery time and carries higher initial surgical risk.
EVAR is a minimally invasive procedure that offers faster recovery, less pain, and lower immediate risk. In some cases, it requires monitoring and additional interventions for complications like endoleaks or graft migration.
Both procedures are performed under general anaesthesia to make sure the patient remains asleep and pain-free during the surgery.
One of the patients of Dr. Dinesh Kumar Mittal, who underwent an Endovascular Aneurysm Repair, expressed, “I was terrified when I learned I had an abdominal aortic aneurysm. Thankfully, Dr. Dinesh recommended EVAR. The surgery was quick, and I was back on my feet in a few weeks. I can’t thank him enough for saving my life.”
What Does Postoperative Recovery after Aneurysm Repair Surgery Look Like?
Recovery after aneurysm repair surgery depends on the type of procedure performed.
- Open surgery can require a longer hospital stay (7-10 days) compared to EVAR (2-4 days).
- Medications are given to manage postoperative pain.
- Slow resumption of daily activities is recommended, with restrictions on high-intensity exercise during the initial recovery period.
- Regular check-ups are done to check that the repair is holding and detect any complications, such as graft leakage or infection.
- Lifestyle modifications are suggested to promote heart health and prevent recurrence.
Dr. Dinesh Kumar Mittal, a renowned heart surgeon, highlights, “Surgery addresses the immediate threat, but long-term success depends on adopting a healthier lifestyle. Regular follow-ups are key to ensuring the repair holds, and your overall health remains optimal.“
What is the Cost of Aneurysm Repair Surgery in India?
The cost of an aneurysm repair surgery in India depends on many factors, including hospital facility, type of surgery, patient’s overall health, and post-surgery recovery. This cost is nearly one-fourth of the cost in the Western nations. The cost of abdominal aortic aneurysm repair surgery lies between INR 2,00,000 to INR 4,00,000 (USD 3000 to USD 5000). The cost of thoracic aortic aneurysm repair surgery is between INR 3,00,000 to INR 5,00,000 (USD 4000 to USD 6000).
Conclusion
Aneurysm repair surgery is a proven intervention that prevents potentially fatal complications and improves quality of life for patients. Early diagnosis, personalised treatment, and proper postoperative care are essential for the best outcomes.
If you or a loved one has been diagnosed with an aortic aneurysm, schedule a consultation with Dr. Dinesh Mittal today.
FAQs
1. What are the benefits of choosing aneurysm repair surgery?
The benefits of going for aortic aneurysm treatment are prevention of rupture, relief of symptoms, extended life expectancy, and improved quality of life.
2. How long does it take to recover after the aneurysm repair surgery?
Recovery from Endovascular Aneurysm Repair (EVAR) takes 2-3 weeks, and from open aortic aneurysm repair can take between 4-6 weeks. Full recovery can take up to 2-3 months.
3. What are the risks related to aortic aneurysm treatment surgery?
Surgical risks include bleeding, infection, formation of blood clots, endoleaks (specific to EVAR), graft-related issues, and nerve or organ damage.
Serious complications like stroke (rare), heart attack, and kidney damage can occur in emergency procedures for ruptured aneurysms.
4. What lifestyle changes are advised after aortic aneurysm treatment?
Patients are advised to maintain a heart-healthy diet, exercise regularly, manage chronic conditions, and avoid smoking and alcohol consumption.
5. What is the success rate of an aneurysm repair surgery?
The success rate of EVAR is approximately 98%, with lower peri-operative risks and faster recovery. For open surgery, this rate ranges between 95-97%. For ruptured aneurysms, the success rate drops to 50- 60%.
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