Aortic aneurysm surgery

Associate Editor-In-Chief:

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 (i.e.: 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 suggests medical management for abdominal aneurysms with a diameter of less than 5.5 cm.