Aneurysm Surgery

Advanced options to repair even the most complex aneurysms

While we may be able to manage small aneurysms with medication and regular monitoring, larger aneurysms or those causing pain or other symptoms may need surgery to prevent the blood vessel from rupturing.

The experts in our Vascular and Endovascular Program and our Cardiac Surgery Program treat all types of aneurysms and offer particular expertise for challenging cases. Patients travel hundreds of miles to receive care from our doctors for complex aneurysms that:

• Involve the aortic root, ascending aorta or aortic arch
• Run across the chest and abdomen (thoracoabdominal)
• Occur in the abdomen.

We often can find a minimally invasive alternative to traditional open aneurysm surgery, even when other doctors have said surgery is not an option. For example, we offer endovascular aortic repair (EVAR), a method that uses a stent-graft, which is a metallic scaffold covered with a synthetic fabric that reinforces the aorta and prevents rupturing. Other programs use stent-grafts only in parts of the aorta, but we use them throughout the aorta. We’re also one of the few programs in the region that uses hybrid aneurysm repair, which combines endovascular repair with open surgery for a less-invasive solution for some complex cases.

Types of aneurysm repair

Endovascular repair

While not appropriate for everyone, this minimally invasive technique can provide benefits over open surgery including smaller incisions, less pain and a shorter hospital stay and recovery. It also may provide an option for people who are too sick or frail for open surgery.

Before the procedure, you’ll be given either general anesthesia or a local anesthetic and sedative. The doctor will make small punctures to access a blood vessel. Using contrast dye and X-ray guidance, they will thread thin, flexible tubes known as catheters through the artery to the aneurysm. The stent-graft will be fixed against the artery wall on either side of the aneurysm, allowing blood to flow through it and avoiding the aneurysm.

The procedure will take one to two hours. You likely will spend a day or two in the hospital to make sure the stent-graft is stable. Your doctor will provide instructions for recovery. Most people are able to return to work after two weeks. You’ll need regular follow-up tests to make sure the stent-graft stays in place.

Learn more about endovascular repair of:

• Thoracoabdominal aneurysms
• Thoracic aortic aneurysms

Traditional open aneurysm surgery

If a minimally invasive approach is not possible, open aneurysm surgery may be the best treatment. Some aneurysm repairs require cardiopulmonary bypass, in which a machine temporarily takes over the function of the heart and lungs. This may be needed to repair aneurysms:

• In the aortic root and ascending aorta
• In the aortic arch
• That run across the chest and abdomen, known as thoracoabdominal aortic aneurysms

For aneurysms that do not require this step, the enlarged section is simply clamped to maintain the most critical blood flow.

In a traditional open repair, you’ll receive general anesthesia, and your doctor will make an incision to access the aneurysm. They will remove all or part of the the damaged blood vessel and replace it with a long-lasting synthetic graft. How long the surgery takes will depend on where the aneurysm is. You likely will need to stay in the hospital five to seven days and take a month or more to fully recover.

Hybrid aneurysm repair

With this method, we can make part of the repair using traditional open surgery while doing the rest with an endovascular approach. These techniques often are used for aneurysms that involve the aortic arch. After your aorta leaves the heart, it curves back toward your chest and abdomen. This area is challenging to repair because the crucial arteries that branch off it supply the brain and arms with blood.

In the past, open surgery was the only option to repair an aneurysm in the arch. This involved putting a patient on a heart-lung machine, lowering their body temperature and stopping normal blood circulation. With a hybrid approach, we can avoid the heart-lung machine as well as cutting into the sensitive aortic arch. This method results in less intense treatment with fewer complications.

In a hybrid aneurysm repair for the aortic arch, your doctor will perform open surgery to graft new blood-supplying arteries to the brain and arms, closer to where the aorta leaves the heart. Then they will thread a catheter toward the aneurysm and open a stent-graft to reinforce the walls of the artery.

We also can perform a similar procedure for aneurysms that involves the ascending aorta, aortic arch and descending aorta. This is known as a hybrid elephant trunk procedure, and it’s often done in two stages, allowing you to recover in between.

Conditions

Tests