There are two main types of treatment for an aneurysm:
- preventative treatment, where an aneurysm is treated to prevent it from rupturing
- emergency treatment, where an aneurysm is repaired after it ruptures
The main preventative treatment is surgery. As with any type of surgery, it carries a risk of complications, some of which are serious.
Therefore, preventative surgery is usually only recommended if it's thought that the risk of a rupture is high enough to justify the risk of surgery.
Preventative treatment for abdominal aortic aneurysm
If you're diagnosed with an abdominal aortic aneurysm, a risk assessment will be carried out to determine the likelihood of the aneurysm rupturing.
The assessment is usually based on:
- your age
- the size of the aneurysm
- how quickly the aneurysm is growing
- whether a parent, brother, sister, aunt or uncle has had a ruptured aneurysm
- whether you have high levels of a chemical called MMP-9 in your blood – high levels of MMP-9 can be caused by extensive weakening of the aortic wall
Usually, the recommended treatment options are:
- active observation if the aneurysm is less than 5cm (see below for more details)
- preventative surgery if the aneurysm is 5–5.5cm (2–2.2 inches) and you have one of the risk factors mentioned above
- surgery if the aneurysm is larger than 5.5cm regardless of whether or not you have any associated risk factors
Active observation
Active observation means that you won't have surgery immediately, but you'll be given regular check-ups so that your aneurysm can be carefully monitored. This usually involves having an ultrasound scan every three or six months.
Lifestyle changes to lower your risk of a rupture will usually be recommended.
If you smoke, the most important change you can make is to stop smoking. People who smoke usually have faster-growing aneurysms than non-smokers. The larger the aneurysm, the higher the risk of it rupturing.
Read more about stopping smoking and nicotine replacement therapies (NRTs) that can make it easier to stop smoking.
Other changes you can make include:
If you have another health condition that's thought to be related to your aneurysm, such as high blood pressure, you may be given medication to treat that condition.
For example:
Surgery
The most commonly used surgical treatment for an abdominal aortic aneurysm is grafting. This involves removing the affected section of the aorta and replacing it with a piece of synthetic tubing known as a graft.
There are two ways that grafting can be done:
- open surgery – a large incision is made in your abdomen to expose the aorta and insert the graft
- endovascular surgery – this involves sticking a thin tube, called a catheter, into one of the arteries in your legs and then guiding it to the aorta. The graft is then moved through the catheter and used to reinforce the aorta wall
Open or endovascular?
In most cases, your surgical team would usually recommend you have endovascular surgery. It has better outcomes than open surgery for preventing death from a ruptured aneurysm (or other complications).
For example, research has found that around 1 in 20 people died in the first 30 days after open surgery compared to 1 in 50 people who had endovascular surgery.
The long-term outcomes are usually better too. The same research found that 12 months after surgery, 1 in 15 people who had open surgery died due to complications related to their aneurysm. Among those who had endovascular surgery, 1 in 25 died from complications.
Another advantage is that endovascular surgery doesn't involve making a large cut into your abdomen, so it has a much quicker recovery time than open surgery.
However, endovascular surgery has its own disadvantages.
The same research found that risks such as the graft splitting or becoming infected were much higher than in open surgery.
Just under half of people who received endovascular surgery experience complications compared with only 1 in 10 people who received open surgery.
If you develop complications, you may need further surgery to correct them.
Your surgical team will be able to make recommendations, but the ultimate decision is yours.
There may be circumstances in which you're not a suitable candidate for endovascular surgery and open surgery would need to be used. For example, you may have unusually narrow blood vessels or an aneurysm in a position that makes endovascular surgery too difficult.
Emergency treatment
Emergency treatment for a ruptured aortic aneurysm is based on the same principle as preventative treatment. Grafts are used to repair the ruptured aneurysm.
Due to the urgent nature of a ruptured aneurysm, the decision to perform open or endovascular surgery may be determined by the expertise and experience of the surgeons available.
Additional medication and treatments may also be used to prevent blood loss and organ damage. For example, nimodipine may be recommended. This medication is used to prevent ruptured blood vessels going into spasm and causing further blood loss.
