Aneurysm Surgery

What Are Aneurysm and Aneurysm Surgery?

Manifesting itself with bulge and dilatation in arteries, aneurysm is seen in 2 to 3% of the population. Although aneurysm can develop at any age, it is more commonly seen at advanced ages. Aneurysms can burst resulting in quite serious problems and there is no medical treatment method, the condition can only be managed with surgery. In conjunction with advancements in medicine, aneurysm surgery that also includes interventional treatments aims to minimize the serious results of disease.

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What is Aneurysm?

Aneurysm implies weakening, dilatation in walls of aorta and brain vessels and formation of bubbles in these regions due to certain results. While aneurysm generally develops in brain vessels and aorta it can also occur in different body parts. The bubbles that do not show any symptoms in many patients are generally nonhazardous, however, rupture of aneurysms in brain vessels and aorta lead to cerebral hemorrhage and internal bleedings. Ruptures develop proportionally to the size of bubbles. In this case, emergency intervention is required.

What Causes Aneurysm?

Aneurysm develops due to weakened or undeveloped intravascular muscle layer, which is located on vessel walls and ensures vascular integrity, secondary to certain congenital and acquired reasons. Researchers conducted demonstrates that some factors trigger aneurysm.

  • Genetic factors,
  • Congenital heart holes,
  • Overweight,
  • Hypertension,
  • Advanced age,
  • Use of drugs, alcohol and cigarette,
  • Tumors,
  • Malnutrition,
  • Atherosclerosis,
  • Heavy stress.
What are the symptoms?

Symptoms of the disease change from person to person depending on some factors and disorders. Signs also alter depending on the location of aneurysm in body as well as the type of aneurysm. Aneurysm may show no signs when the bulge is small or develops slowly. In this case, vessels can rupture suddenly and leads to serious results.

General symptoms of aneurysm are as follows:

  • Pain at the location of aneurysm,
  • Bleedings in these regions,
  • Loss of consciousness,
  • Abnormally accelerated heart rate,
  • Hypotension,
  • Dizziness,
  • Nausea and vomiting,
  • Contractions and epilepsy seizures
  • Visual disorders,
  • Fatigue,
  • Facial numbness or paralysis,
  • Photosensitivity.

None of these signs may be seen if aneurysm does not burst. Some patients show one of these signs while some of them experience all of them. In some cases, symptoms of the disease causing aneurysm manifest themselves. Severe and frequently recurring headache is one of the most critical signs of brain aneurysms. Headaches especially which worsen after physical activities like sports and after sexual intercourse can also be sign of brain aneurysm.

What Are the Types of Aneurysm?

Aneurysms are classified according to the region they develop on vessel wall and development patterns. According to their development patterns, aneurysms are classified as saccular (sac-like) and fusiform (flat dilatation on vessel wall) aneurysms. Weakness can be seen in a certain, small part of vessel wall in saccular aneurysm. This weakness that develops rapidly and tends to bleed is generally observed in brain while it may also develop in internal organs like spleen and kidney.

In fusiform aneurysm, a symmetrical weakness can be seen on the whole vessel wall. This type of aneurysms shows slower development comparing to saccular aneurysms. Moreover, bleeding is less likely. Generally, aortic aneurysms are included in this group.

Aneurysms are also classified according to their locations in body:

Brain Aneurysm

Bubbles forming in vessels as a result of damage or weakening in brain vessels are called brain aneurysm. Brain aneurysm, also known as cerebral aneurysm, is the most dangerous type of aneurysm as the vessels are nondurable and have tendency to rupture.  In some cases, where bubble is significantly small, no sign is seen. Brain aneurysm can be caused by damages during delivery while it may also develop secondary to traumas and various disorders.

Aortic aneurysm

 Aortic aneurysm is divided into two groups, namely thoracic aortic aneurysm (TAA) and abdominal aortic aneurysm (AAA), and it affects the main vessels of body. Aneurysms in abdomen, legs and thoracic regions develop due to reasons such as atherosclerosis.

Pseudo aneurysm

Psudoaneurysm, also known as false aneurysm, implies the type of aneurysm in which ruptures are seen in spite of non-existence of a bulge on vessel wall. Stent, trauma and various infections are among the most important causes of pseudo aneurysm.

How is it diagnosed?

Aneurysm is diagnosed with imaging methods. Aneurysms can be detected and diagnosed thanks to Magnetic Resonance (MRI) and computed tomography. Cerebral angiography provides more detailed information comparing to these imaging methods.

Ruptured aneurysm is diagnosed with a different method using cerebrospinal fluid. Presence of blood in cerebrospinal fluid is a sign of ruptured aneurysm. The treatment deemed appropriate by the physicians should be started after aneurysm is diagnosed.

What is Aneurysm Surgery?

Today, aneurysm developing in aorta and brain vessels secondary to various causes is treated with surgical methods. Aneurysm surgery includes all methods utilized against the risk of rupture as a result of severe dilatation in some cases and against aneurysm bleedings in some cases.

What Are the Surgical Methods?

Surgical intervention is strictly required if aneurysm on cell wall ruptures and bleeding occurs. In addition to open surgical interventions, laparoscopic surgeries are also performed to manage aneurysms. The appropriate surgical method for the patient is decided according to the location, type and size of aneurysm.

Open Surgery

This method, also known as clipping the aneurysm, is performed under general anesthesia. The aim of clipping method, which was first used in 1937, is to close the region where aneurysm is present. A part of skull is removed and location of aneurysm is reached during the surgery. Similarly, a large incision is made on abdominal region and/or chest wall to reach the vessel in aortic aneurysm. Next, several clips produced from titanium are generally placed to the neck of aneurysm to stop the blood flow. Clipping is finished by stitching the meninges and skull.

Open surgeries generally last for 2 to 6 hours or longer and they may cause certain complications. If no complication is experienced, patients recover within 10 days on average.

Endovascular Method

No incision is made on patient’s body in endovascular method which generally includes reaching to the vessel where aneurysm is located from the inguinal region. In this method which started to be used in 1970s, a catheter is placed in the vessel where aneurysm is located through the inguinal region under guidance of imaging devices. It is possible to place platinum wires into the vessel thanks to this catheter. The wires that form clot in vessel are placed in configuration of coil. Therefore, blood flow into bubbles is prevented. The formed clot, induces the clip effect similar to open surgeries. Stent can be placed in this region to prevent the wires placed in aneurysm from reaching to the aorta.

Closed surgery method that generally lasts for 1 to 2 hours is preferred as it is less painful and induces lower risk of complication comparing to open method. Patients can recover within a few days. In spite of these advantages, closed surgery can be riskier as the risk of recurrence of bleeding is higher and complications during procedure are more challenging to be controlled comparing to open surgery.

Frequently Asked Questions

What is the possibility of bleeding in aneurysm?

Possibility of bleeding in aneurysm is not exactly known. It is only possible to make predictions about whether bleeding will occur in aneurysm and the severity of bleeding based on some data. Location, size and shape of aneurysm are observed and assumptions are made regarding possibility of bleeding. Generally, bleeding recurs in ruptured aneurysms; therefore, patients should be immediately taken under follow-up.

What is the reason of bleeding in aneurysm?

Time and underlying causes of these bleedings are not certainly known in brain and aortic aneurysms. Moreover, there are some factors that cause bleeding. Hypertension, severe mood disorders secondary to stress and bad temper, strenuous physical activities increasing pressure in vessels, smoking, drug abuse and some drugs such as amphetamine are among the factors that can cause bleeding.

Is it possible to prevent aneurysm?

Aneurysm mostly occurs after the age of 35 and it is generally associated with congenital health problems. Moreover, changes in lifestyle are also among the ways to prevent rupture and bleedings. Regular physical activities, avoiding from smoking, having a healthy and balanced diet, avoiding from excessive stress and having regular check-ups are among the precautions that should be taken.

Which surgical method used in treatment of aneurysm is better/more appropriate?

Effects of surgical methods used both in aorta and brain aneurysms for long years have been proven. The method to be used for treatment is determined depending on progression and condition of the disease. In addition, each method has advantages and disadvantages. Open surgeries can cause quite risky and severe complications. On the other hand, there is a risk of recurrence of aneurysm in closed surgeries. Specialists determine the most suitable method according to patients’ conditions.

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