Management of an Aortic Aneurysm
Management and treatment of an aortic aneurysm is guided by two parameters:
- Symptomatic vs. asymptomatic
- Hemodynamically stable vs. unstable
The most conservative measures are used for those who are asymptomatic and hemodynamically stable. An asymptomatic but diagnosed aneurysm is followed by CT measurements, but if signs or symptoms become emergent, ultrasound–even bedside ultrasound–are the most rapid way to determine if timely surgical preparation is necessary.
An aneurysm diagnosis is established when the full-thickness dilation of a blood vessel is >50% larger than its normal diameter (2-3 cm). For clinical purposes, aortic aneurysm is recognized to have a diameter > 3 cm. Regardless, if the aneurysm has a diameter measurement of >5.5 cm, or if serial measurements determine that it is expanding at >1/2 cm/year, surgical treatment is indicated due to the high risk for catastrophic, life-threatening rupture.
Only 1/2 of patients with a ruptured aneurysm survive, making pre-emptive management and treatment necessary once the diameter measurements indicate the patient’s transition into a higher risk category.
Pain management is indicated for those with symptomatic aneurysm who are stable. The physician must be careful to not mask the pain completely as a change in pain perception could indicate rapid expansion or imminent rupture.
Invasive Repair of Aneurysm
There are two methods of repairing an aneurysm, based on inclusive or exclusive criteria, once there is an urgent or emergency scenario in play:
- Open repair: Replacement of the aortic segment with a graft through an incision.
- Endovascular aneurysm repair (EVAR): Placement of a modular graft through threading it via the iliac or femoral arteries, to wall off the aneurysm sac from the circulation.