Aortic Aneurysm Treatment

The goal of treating an aortic aneurysm is to prevent dissection or rupture, the likelihood of which increases with the size of the aneurysm. Once an aneurysm develops along the aorta, it will not disappear or reduce in size on its own. Some small aneurysms will remain stable in size for many years, while others increase in size over time. Most aneurysms grow at rates less than ¼ of an inch per year; however, growth rates can vary substantially between aneurysms.

Treatment depends on size, type, and location of the aneurysm as well as a person's general health. If the diameter of an aneurysm is small (less than 1 1/2 inches) and there are no symptoms, your doctor may suggest a watch-and-wait approach while prescribing medications to control your blood pressure and lipid levels. Although these medications are used to slow the growth of an aneurysm, they are not a cure. Eventually, most aortic aneurysms will need to be repaired to avert rupture or dissection.

This section contains more information on:

• Criteria for surgical repair
• Monitoring
• Medication
• Open abdominal or open chest surgery
• Endovascular surgery
• Treatment of aortic dissections

Criteria for surgical repair

Repair of an aortic aneurysm is recommended when the risk of rupture or dissection outweighs the risk of surgery. Risk of death resulting from surgical repair can be as low as less than 1 percent for an otherwise healthy person, depending on the location of the aneurysm. Research has shown that a 2-inch-wide aneurysm has a 5 percent or 1 in 20 chance of rupturing within one year; a 2 ¾-inch aneurysm has a 20 percent—or 1 in 5—chance of rupture within one year.

For most people, the repair of an aortic aneurysm is recommended if one or more of these criteria are met:

• Size—aneurysms 2 inches in diameter or larger
• Growth rate—aneurysms increasing in size at more than 1/8 to 1/4 inch per year
• Symptoms—onset of symptoms
• Leakage-positive evidence of leakage

When an aortic aneurysm meets any of these criteria, surgical repair should be considered. However, individual circumstances can supersede these criteria. For instance, surgery to repair an aneurysm may be considered earlier for people with Marfan syndrome or people who have a bicuspid aortic valve.

Aortic aneurysms that have ruptured or dissected may be repaired with emergency surgery, but the outcome is not generally as good as when the aneurysm is electively treated before it ruptures. Furthermore, many people with a ruptured aortic aneurysm die before they reach the hospital. Therefore, elective surgical repair to avert an aortic rupture or dissection is highly recommended.