Dr. Vicente Riambau is a vascular surgeon and belongs to Top Doctors, the select circle of top doctors in Spain. As an expert in aortic aneurysm, he will explain the details of this surgery.
What is an aortic aneurysm and what symptoms does it present?
An aortic aneurysm is the dilation of the main artery of the body called the aorta artery. The most common would be the infrarenal aortic aneurysm, located in the abdominal area, followed by the popliteal artery aneurysm at the knee and then the thoracic aortic aneurysm in the part that is comprised above the diaphragm. They have no symptoms which is a drawback since when they begin to be noticed it is probably due to the initiation of a rupture, therefore we would be facing an emergency situation with very remote chances of survival. It is highly advisable, therefore, to detect these aneurysms in advance and be able to fix or repair them before the symptoms occur, before the rupture occurs.
What are the causes and how can they be prevented?
The causes of aortic aneurysms are varied, but fundamentally they are due to something that everyone could agree on, which would be the aging of the arteries. But there are also a series of predisposing factors, the most important of which would undoubtedly be tobacco consumption, smoking, followed by hypertension and hypercholesterolemia. There are aneurysms that are familial, i.e. congenital defect, not well identified, but there are families of individuals with aortic aneurysms, either abdominal or thoracic. To prevent it, the best way is to detect these aneurysms previously by ultrasonography, by Doppler ultrasound, and in those patients who have some risk factor or who have a family history of aneurysms and that as a general rule would be male patients, over 65 years old, smokers and who have had a family history of aortic aneurysms. An ultrasound can confirm or rule out the presence of an aortic aneurysm.
How is your surgery and the post-operative period?
Currently we have 2 techniques that we can apply to patients with aortic aneurysms. One is the traditional or conventional, open surgery, which involves the replacement of the aortic artery that is diseased by a vascular prosthesis with manual suture and involves major surgery, which involves general anesthesia with blood transfusion and a long postoperative period of 30-40 days. The alternative, fortunately, is endovascular surgery, which is a recent addition to our therapeutic arsenal but allows the application of an endoprosthesis by catheterization technique, without the need to open the patient, only with the endovascular application of vascular prostheses with automatic fixation or self-anchoring. There are also self-sutures that allow a good fixation of the stents. Both can be equally feasible in patients, bearing in mind that they are highly complex techniques that must be performed in specialized centers. The technique or medical therapeutics is still far beyond our reach, although research is being done on some drugs that can prevent the growth of the aorta.