Aortic aneurysm repair is a critical surgical intervention aimed at preventing life-threatening complications such as rupture or dissection. The procedure chosen depends on factors like aneurysm size, location, overall health, and the patient’s eligibility for surgery. There are two primary approaches to repairing an aortic aneurysm:

1. Open Surgical Repair (OSR)

This traditional and time-tested method involves open surgery to remove the diseased section of the aorta and replace it with a durable synthetic graft. It is typically recommended for larger aneurysms, rapidly growing aneurysms, or cases where endovascular repair is not feasible.

Procedure Steps:

Anaesthesia: General anaesthesia is administered to ensure the patient remains unconscious and pain-free throughout the procedure.

Incision: The surgeon makes a large incision either in the chest (for a thoracic aortic aneurysm, TAA) or the abdomen (for an abdominal aortic aneurysm, AAA).

Aortic Clamping: The aorta is clamped above and below the aneurysm to stop blood flow.

Aneurysm Removal: The weakened section of the aorta is surgically removed.

Graft Placement: A synthetic tube, often made of Dacron or polytetrafluoroethylene (PTFE), is sewn in place to replace the damaged segment.

Closure: The graft is secured with sutures, and the incision is closed using stitches or staples.

Advantages of OSR:

Highly durable with long-lasting results.

Suitable for patients with large, complex, or irregularly shaped aneurysms.

Reduces the risk of future aneurysm-related complications.

Disadvantages of OSR:

A highly invasive procedure with a longer recovery time, typically 6-8 weeks.

Greater risk of surgical complications such as bleeding, infection, and organ damage.

Requires a longer hospital stay (often 7-10 days).

Not always suitable for elderly patients or those with significant underlying health issues.

2. Endovascular Aneurysm Repair (EVAR/TEVAR)

Endovascular aneurysm repair is a less invasive alternative designed to reinforce the weakened section of the aorta using a stent graft. This approach is commonly used for patients who are at high risk for open surgery or those with aneurysms in accessible locations.

EVAR (Endovascular Aneurysm Repair) is used for abdominal aortic aneurysms.

TEVAR (Thoracic Endovascular Aneurysm Repair) is used for thoracic aortic aneurysms.

Procedure Steps:

Anaesthesia: The patient receives either local or general anaesthesia.

Catheter Insertion: A small incision is made in the groin, and a catheter is introduced into the femoral artery.

Aortic Stent-Graft Placement: A flexible, mesh-like stent covered with fabric is guided through the artery and positioned at the aneurysm site.

Deployment and Sealing: The stent is expanded, reinforcing the aortic walls and reducing pressure on the aneurysm.

Blood Flow Restoration: The graft helps redirect blood flow through the aorta, preventing further expansion of the aneurysm.

Advantages of EVAR/TEVAR:

Minimally invasive, resulting in smaller incisions and less blood loss.

Lower risk of infection and postoperative complications.

Shorter hospital stay, often requiring only 1-3 days.

Faster recovery, with most patients resuming normal activities within 1-2 weeks.

Disadvantages of EVAR/TEVAR:

Not suitable for all patients, as aneurysm shape, size, and location determine eligibility.

Requires lifelong monitoring with regular imaging (CT scans or ultrasounds) to ensure the graft remains stable and functional.

Possibility of endoleaks (blood leaking around the stent), which may require additional intervention.

Aortic Aneurysm Repair: Preventing the Silent Threat