“Aortic aneurysm does not hurt”. This phrase, despite being so paradoxical, is absolutely true.
Aortic aneurysm – a dilatation of the aortic artery – is a disease that in most cases is asymptomatic, despite its not inconsiderable frequency. Thus, every month patients die in Andalusia, and these deaths occur because the patients arrive at the hospital with no chance of cure.
Normally, the patient affected by abdominal aortic aneurysm comes to the emergency department with severe abdominal pain, and have a rapid deterioration (often die at home or during transfer). The rupture in the artery produces severe bleeding, which is usually lethal.
Aortic aneurysm is a disease that occurs more frequently in men over 60 years of age with a history of smoking. Even though the patient has stopped smoking, the risk remains.
The diagnosis, by chance
Fortunately, new technologies and imaging techniques (performed for another reason) reveal this problem and allow its diagnosis in many cases. This is why it is common to find and diagnose the aneurysm when performing a CT scan for abdominal pain or when checking the prostate.
The Preventive Service Task Force of the United States recommends that male patients over 65 years of age who have smoked at some stage of their lives undergo an ultrasound scan. If an aortic aneurysm is detected, the patient will be referred to a specialist. If these same criteria were applied in Spain it would help a lot, since surgeons would be able to face open or endovascular surgery of this pathology with more guarantees.
What is the surgery like?
Aortic aneurysm surgery is performed when the aneurysm is larger than 5 or 5.5 centimeters, or when its shape is irregular and there is more risk of rupture.
The results of surgery when the aneurysm has a size of 5 or 5.5 cm are better than when it has already ruptured or complicated.
The development of endovascular aneurysm surgery has allowed us to address the treatment of this disease with a perioperative mortality rate of less than 1%, since it is a much less aggressive technique that is performed through the femoral arteries themselves and without the need to open the belly. This surgery is usually performed on patients between 70 and 90 years of age.
Sedation or local anesthesia may be used. Although anesthesia levels can be increased in cases where the patient has no anesthetic risk and if he/she prefers to be more comfortable during surgery.
As such, endovascular surgery is based on implanting a coated prosthesis that is responsible for transporting the blood inside the aneurysm itself, thus preventing the aortic wall from supporting the blood pressure itself, which is contained by the prosthesis. The surgery is very fast, and requires a postoperative period not exceeding 48 hours.
At the same time, it should be mentioned that preparation and planning are fundamental in this surgery, being the previous CAT scan fundamental to avoid potential complications. Thanks to this technique, excellent results are achieved with almost 0% mortality.
In cases of emergent surgery for rupture, the mortality rate increases up to 25 or 30% of cases, since on many occasions patients do not arrive alive at the hospital. In patients with rupture and more risk factors, mortality of ruptured aneurysm can reach up to 70%.
Perhaps if the aneurysm hurt before rupture, patients with ruptured aneurysms would have a higher survival rate.
For more information about aneurysm and its treatments, please consult with an expert in Cardiovascular Surgery.