Aortic Aneurysm: What You Need to Know About New Minimally Invasive Treatments

Aortic aneurysms are defined as a dilation of the aorta, the body’s main artery that carries blood from the heart to the rest of the body. The treatment of aortic aneurysms requires a high level of expertise and specialized training. Dr. Theodosios Bisdas,Director of the 3rd Vascular Surgery Clinic of the Athens Medical Center, answers the most critical questions.

What are aortic aneurysms and what risks do patients face?

An aortic aneurysm aneurysm is a dilation of the aorta to 2.5 times its normal diameter. In essence, the wall of the aorta weakens and expands, usually taking on a balloon-like shape. When the aneurysm exceeds 5.5 cm, the risk of rupture increases exponentially. Approximately 75% of patients with a ruptured aneurysm die before reaching the hospital, while of the remaining 25%, about half do not survive surgery or the postoperative period.

How can I have an aortic aneurysm?

Unfortunately , aortic aneurysm rarely cause symptoms. Most aneurysms are diagnosed incidentally during: • urological examinations for prostate enlargement in men • orthopedic evaluation for lower back pain in both sexes • gynecological examinations in women It should also be noted that male sex increases the likelihood of developing an abdominal aortic aneurysm by approximately 4.5 times. Ultrasound screening (duplex/triplex scan) using portable devices has been shown to be an effective and cost-efficient method for preventing deaths from ruptured aortic aneurysms.

Which Patients Should Be Screened for Aortic Aneurysm and When Should It Be Treated?

The European Society of Cardiology recommends ultrasound screening for abdominal aortic aneurysm in all men over 65 years of age, as well as in women over 65 years of age with a history of smoking. In addition, first-degree relatives of patients with a history of abdominal aortic aneurysm should undergo similar screening. In general, periodic monitoring is recommended annually for aneurysms measuring 3.5–4.4 centimeters, and every 6 months for aneurysms measuring 4.5–5.4 centimeters. When the aneurysm reaches a diameter of 5.5 centimeters or causes symptoms not related to another cause, immediate repair is recommended.

 

Aortic aneurysm: Treatment

Endovascular repair of the aortic aneurysm has become a widely accepted, minimally invasive, and safe method for treating the disease. Nowadays, next-generation grafts are used, which ensure successful exclusion of the aneurysm. The procedure is performed under general anesthesia and the grafts are placed percutaneously in the aorta. Depending on the location of the aneurysm, there are also corresponding endografts/stents.

Abdominal aortic aneurysms: treatment

Abdominal aortic aneurysms, which are also the most common, are treated with bifurcated endografts. Special endografts with integrated branches or fenestrations are used for more complex aneurysms of the aortic arch and thoracoabdominal aorta. In these cases, the complexity lies in the fact that the aneurysms involve important branches that either supply blood to the brain or to the abdominal organs, and these must necessarily be connected to the stent (Figure 1).

Image 1. Minimally invasive endovascular repair of a ruptured aortic arch aneurysm (A = before, B = after), Endovascular repair of a thoracoabdominal aortic aneurysm (C = before, D = after).

What are the advantages of endovascular repair of aortic aneurysms?

Compared with the classic Compared with open surgical treatment, the main advantages of endovascular treatment of complex aortic aneurysms are the following:

1. Minimization of surgical trauma.
2. Absence of postoperative pain.
3. Minimal blood loss.
4. Immediate mobilization of the patient.
5. Short hospital stay of a few days.
6. Avoidance of extracorporeal circulation and its potential complications.

The use of carbon dioxide instead of iodinated contrast medium in patients with kidney disease.

Until recently, the endovascular repair of aortic aneurysms, as well as other vascular diseases, was contraindicated in patients with renal failure due to the toxic effect of iodinated contrast media on the kidneys. Nowadays, iodinated contrast medium can, in specific cases, be fully replaced by carbon dioxide, which is kidney-friendly and provides excellent quality imaging of the blood vessels. At the [Athens Medical Center](https://www.iatriko.gr/en?utm_source=chatgpt.com), the first successful total endovascular repair of an aortic aneurysm and the first treatment of diabetic foot disease via CO₂ angiography were recently performed in a patient with iodine allergy and chronic renal failure, respectively (Image 2).

Image 2. Excellent quality imaging of the renal arteries during placement of the endograft for the treatment of an abdominal aortic aneurysm.

The management of aortic aneurysms in specialized aortic disease centers

Regardless of their extent or complexity, aortic aneurysms should be treated in specialized aortic centers. These centers must meet the following requirements:

1. Modern Hybrid Clinic which combines a high-resolution angiography system and the capability for open surgical intervention.
2. A stock of grafts and specialized materials for emergency situations.
3. Specialized nursing staff in endovascular techniques.
4. Collaboration between various specialties for the best patient care.
5. Specialized intensive care unit.
6. An experienced vascular surgery team in new minimally invasive endovascular techniques.

  If you have been diagnosed with an aortic aneurysm or would like to learn more about its prevention and treatment, contact the… Dr. Theodosios BisdasFor specialized solutions and safe treatments with modern medical technology. Book an appointment today to receive your personalized treatment.