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 Is an Aortic Aneurysm and What Are the Risks for Patients?
An aortic 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 Know If I Have an Aortic Aneurysm?
Unfortunately, aortic aneurysms 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, or 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 aortic aneurysms has become a widely accepted, minimally invasive, and safe method for treating the disease. Today, latest-generation grafts are used to successfully exclude the aneurysm from the circulation. The procedure is performed under general anesthesia, and the grafts are inserted percutaneously into the aorta. Depending on the location of the aneurysm, different types of endografts/stent grafts are used.
Abdominal Aortic Aneurysm Treatment
Abdominal aortic aneurysms, which are the most common type, are treated with bifurcated endografts. Specialized endografts with branched or fenestrated designs are used for more complex aneurysms involving the aortic arch or thoracoabdominal aorta. The complexity of these cases lies in the fact that the aneurysm involves major arterial branches supplying either the brain or the abdominal organs, and these branches must be preserved and connected appropriately to the stent graft.
Figure 1. Minimally invasive endovascular repair of a ruptured aortic arch aneurysm (A = before, B = after), and endovascular repair of a thoracoabdominal aortic aneurysm (C = before, D = after).
What Are the Advantages of Endovascular Repair for Aortic Aneurysms?
Compared with conventional open surgery, the main advantages of endovascular treatment for complex aortic aneurysms include:
- minimization of surgical trauma
- no significant postoperative pain
- minimal blood loss
- rapid patient mobilization
- short hospital stay
- avoidance of cardiopulmonary bypass and its potential complications
Use of Carbon Dioxide Instead of Iodinated Contrast in Patients With Kidney Disease
Until recently, endovascular repair of aortic aneurysms and other vascular diseases was often not feasible in patients with renal insufficiency, due to the toxic effects of iodinated contrast agents on the kidneys. Today, in selected cases, iodinated contrast can be completely replaced by carbon dioxide (CO₂), which is kidney-friendly and provides excellent vascular imaging quality. At Athens Medical Center, the first successful total endovascular repair of an aortic aneurysm using carbon dioxide angiography was recently performed. The same technique was also used in the first treatment of a diabetic foot patient with iodine allergy and chronic kidney disease, respectively.
Figure 2. High-quality visualization of the renal arteries during deployment of an endograft for the treatment of an abdominal aortic aneurysm.
Treatment of Aortic Aneurysms in Specialized Aortic Centers
Regardless of their extent or complexity, aortic aneurysms should be treated in specialized aortic centers. These centers should meet the following requirements:
- a modern hybrid operating room combining a high-resolution angiography system with the capability for open surgical intervention
- immediate availability of grafts and specialized materials for emergency cases
- nursing staff trained in endovascular techniques
- collaboration between multiple medical specialties for optimal patient care
- a specialized intensive care unit
- an experienced vascular surgery team with expertise in advanced 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 Dr. Theodosios Bisdas. Receive specialized care, modern minimally invasive treatment options, and a personalized therapeutic approach based on the latest medical technology. Book your appointment today to receive your individualized treatment plan.
