Aortic aneurysm – complications and treatment

Aortic aneurysm: possible complications

Depending on the location of the protrusion, the following undesirable side effects of aortic aneurysms are known: Complications that can be explained by mechanical pressure on surrounding structures, such as  hoarseness  due to damage to the laryngeal nerves,  difficulty swallowing  and  shortness of breath . However, as the aneurysm grows, blood flow to other organs or to the arms and legs can also be severely impaired.

If blood clots form in the swollen aneurysm sacs, they can also be the starting point of embolisms, for example in the brain, and thus of  strokes  . The most serious complication of all types of aneurysms is definitely when the aneurysm ruptures. Very few patients survive this emergency situation.

Treatment of an aortic aneurysm

The following treatment options are available for an aortic aneurysm:

• drug therapy for hypertension
• Open surgery
• Insertion of a vascular prosthesis from the groin (endovascular surgery)

Drug therapy of the aortic aneurysm

If it is possible  to bring risk factors  such as  high blood pressure , dyslipidemia or  obesity  under control with medication or other measures, the aortic aneurysm cannot be cured, but the course of the disease can be positively influenced in most cases.

The main aim of the treatment here is to prevent the critical enlargement of the aneurysm to more than 5 to 6 cm in diameter and thus reduce the likelihood of the aneurysm rupturing.

Open surgery of the aortic aneurysm

There are two surgical procedures to choose from to treat an aortic aneurysm. In the so-called  open vascular surgery  , the abdominal aorta is exposed and the part with the aortic aneurysm is replaced with a  vascular prosthesis  consisting of a plastic tube. Although this operation is very stressful for the patient, it offers a safe cure, so that further checks are not necessary.

Since an emergency operation on a ruptured aortic aneurysm is only successful in very few cases, the doctor treating you after diagnosing an aortic aneurysm mainly has the task of monitoring the development of the aneurysm through regular follow-up examinations and determining the right time for the operation.

 In individual cases, the risk of the operation itself –  especially in older patients with additional heart or lung diseases  –  and the risk of not operating and thus accepting a possible bursting of the aortic aneurysm must be weighed against each other .

Endovascular surgery of the aortic aneurysm

An alternative treatment method that does not require opening of the abdominal wall and is therefore much  less stressful for the patient  has become established over the past few years.

With the patient awake, a vascular prosthesis (stent prosthesis) is inserted into the vascular system via the inguinal artery,  lining and stabilizing the area of ​​the aneurysm from the inside.

A  disadvantage of this form of treatment  , however, is the need for lifelong regular monitoring. In addition, multiple follow-up surgeries may be necessary because the stents do not last indefinitely and can leak over time.

Not every patient and not every aneurysm is suitable for this procedure. However, in patients who cannot be operated on because of their age or other illnesses, the insertion of the vascular prosthesis is often the only available treatment option.

preventive measures

For the prevention of aortic aneurysms, essentially all measures are suitable that prevent vascular diseases or at least can favorably influence their course. These include weight regulation in the case of obesity, stopping smoking, effective treatment of high blood pressure or  diabetes , dietary measures for lipid metabolism disorders or  gout , reduction of psychological stress factors and regular physical training.

Unfortunately, genetic factors as the cause of aortic aneurysms cannot be influenced today either by medical treatment measures or by personal rules of conduct.

Since January 2018,  men over the age of 65 with statutory health insurance have been  entitled to a one-time  check  -up for the early detection of aneurysms in the abdominal aorta. Because this group has a particularly high risk of aortic aneurysms. During the examination, the doctor performs an abdominal ultrasound, which allows him to measure the thickness of the abdominal aorta and thus determine any changes in the main artery.