Aneurysm repair methods vary with the type of aneurysm involved, and on the risk of it bursting. All of the primary methods of repair are surgical. Depending on their location, aneurysms may be removed through vascular surgery or major cardiovascular surgery, both of which involve inserting synthetic support inside the blood vessel. Ruptures call for immediate surgery to seal the artery. Supporting treatments such as hypertension management, anti-clotting drugs may be used with any surgical repair method.
Aneurysms occur when the wall of an artery has become weak and subsequently dilated due to conditions such as cardiovascular disease or trauma. Rupture of the aneurysm tears the vessel wall, causing bleeding that is often life-threatening. Aneurysm repair is either elective preventive surgery to prevent the blood vessel from bursting, or emergency surgery to close a ruptured aneurysm and prevent further hemorrhage. The decision to have elective surgery is based on factors such as the size of the aneurysm and its closeness to major organs.
Thoracic aortic aneurysms cause expansion of the aorta of the heart. If untreated, these will prove fatal — their eventual rupture leads to death in a matter of minutes. Surgical aortic aneurysm repair typically places a fabric cylinder supported by a metal structure — an endovascular stent-graft — inside the artery. While endovascular stents are inserted by threading a catheter in the blood vessel, ruptured aneurysms require emergency open surgery to close the artery and to prevent further bleeding.
Abdominal aortic aneurysms are the most common form of aneurysm, frequently occurring in the renal or intestinal arteries. They vary greatly in size, so treatment tends to be more aggressive with larger aneurysms presenting an increased rupture risk. Surgical repair replaces the weakened portion of the arterial wall with a synthetic graft. Sometimes endovascular aneurysm repair uses a catheter to place a stent in a relatively straightforward procedure. If the renal blood supply is endangered from an infrarenal aneurysm above the kidney, major surgery is required to construct a bypass of the affected blood vessels.
Cerebral or brain aneurysms can occur anywhere in the skull, but are most common in the arteries at the base of the brain that are known as the Circle of Willis. The primary cerebral aneurysm repair method is surgical clipping, a neurosurgical operation in which a clip seals a ruptured or bulging arterial wall. Carotid aneurysms are rare but threaten the blood supply to the brain by impairing one of the two carotid arteries of the neck. If above a certain size, the expanded part of the carotid artery is surgically excised, and a bypass is inserted to compensate for the interruption of blood supply.