Aneurysm: Abdominal, Aortic, Thoracic and Peripheral

An aneurysm is a bulging, weakened area in the wall of a blood vessel, resulting in an abnormal widening or ballooning greater than 50 percent of the vessel's normal diameter.

While an aneurysm may occur in any blood vessel, but is most often seen in an artery, an abdominal aortic aneurysm (AAA) occurs in the wall of the aorta (the largest artery in the body) within the abdomen. A thoracic aortic aneurysm (TAA) occurs in the wall of the aorta within the chest. More 150,000 Americans are diagnosed with an aneurysm each year, with most cases involving the aorta. Left untreated, aortic aneurysms can rupture and cause potentially life-threatening complications.

Peripheral aneurysms affect arteries that branch off of the aorta. The most common peripheral aneurysm occurs in the popliteal artery, which is located behind the knee. They also can occur in other arteries that supply the limbs with blood. Although peripheral aneurysms are not likely to rupture, they often cause pain, swelling or numbness.

Specialists at the Brigham and Women’s Hospital (BWH) Heart & Vascular Center are committed to providing comprehensive, compassionate and innovative care to patients who require treatment for aortic and peripheral (non-cerebral) aneurysmal disease. Our Acute Aortic Rapid Response Team, responds immediately to patients on site, and is part of our Aortic Disease Center which monitors and manages both patients at risk and post-surgical cases.

Watch a video with Edwin C. Gravereaux, MD demonstrating how the endovascular repair of an abdominal aortic aneurysm (AAA) is performed.

Aneurysm Topics

Risk Factors for Aneurysm

There are a number of factors that may contribute to the development of aneurysmal disease, including:

Symptoms of Aneurysm

Most aortic aneurysms are asymptomatic. Some aneurysms, however, may produce symptoms such as intense back or abdominal pain. The major risk of an aortic aneurysm is a rupture that results in severe or fatal internal bleeding. Ruptured abdominal aortic aneurysms are the 13th leading cause of death in the United States, with over 15,000 Americans dying each year.

Diagnosis of Aneurysm

At Brigham and Women’s Hospital, our vascular specialists provide expert evaluation and diagnosis with the aid of the latest in advanced imaging technologies. Along with performing a careful physical examination, the physician may order one or more of the following tests or procedures:

  • Aortic ultrasound
  • Abdominal CT scan

It is recommended that men between the ages of 65 and 75 who have ever smoked tobacco get screened for an abdominal aortic aneurysm, even if they don’t have symptoms. Men 60 or older who have a family history of AAA should also consider getting tested.

Treatment for Aneurysm

Our vascular specialists develop individualized treatment plans for patients based on:

  • Age
  • Overall health
  • Medical history
  • Severity of the disease
  • Tolerance for specific medications or procedures
  • Expectations for course of the disease
  • Presence of other conditions

Treatment for aortic aneurysm at the Heart & Vascular Center includes:

Surgery

Small aortic aneurysms can be monitored, and, in some cases, medications can be used for treatment. Aortic aneurysm repair, however, is typically recommended when the aneurysm becomes at greater risk for rupture due to its size or rate of growth. Repair procedures can be done numerous ways, depending on the patient’s individual needs.

  • Aneurysm Repair – Traditional open surgery is a major surgical procedure that is performed through an incision in the abdomen. The aneurysm is repaired by replacing the diseased segment of the aorta with an artificial graft that is sewn into place. This approach is very effective for most patients, but it requires a large incision and a five- to seven-day hospital stay.
  • Endovascular Repair – An excellent option for patients with appropriate anatomy and those who are elderly or may not be good candidates for open surgery, this minimally invasive procedure is performed through a small incision in the groin. Imaging is used to guide a catheter with the graft to the weakened area of the wall of the aorta, and the graft is then expanded against the wall. Patients generally return home two days after endovascular repair and are monitored in regular follow-up visits to check for any complications.

Aneurysms in other parts of the body, such as the legs, can be removed with bypass surgery (open surgery) or minimally invasive surgery.

What You Should Expect

The Heart & Vascular Center is located in the Shapiro Cardiovascular Center, across the street from BWH’s main 75 Francis Street entrance. The Heart & Vascular Center brings together the full range of services in one location, fostering seamless and coordinated care for all cardiovascular patients.

If you are having surgery or a procedure, you will likely be scheduled for a visit to the Weiner Center for Preoperative Evaluation or the Watkins Clinicfor pre-operative information and tests.

The day of surgery, you care will be provided by surgeons, anesthesiologists and nurses who specialize in surgery for patients with aneurysms. After surgery, you will go to the post-surgical care unit where you will receive comprehensive care by an experienced surgical and nursing staff.

During your surgery, family and friends can wait in the Shapiro Family Center. Staff members will provide surgery updates and caregivers who leave the hospital will be contacted by cell phone.

Learn more about your hospital stay and returning home.

Multidisciplinary Care

In addition to our cardiac surgeons, patients also benefit from the teamwork of medical cardiologists, interventional cardiologists, cardiovascular imaging experts and radiologists, and anesthesiologists, all expert in cardiac valve disorders. They work alongside nurses, physician assistants, physical therapists, dietitians and social workers to achieve outstanding outcomes for our patients.

Resources

Learn more about aneurysms in our health library.

Visit the Kessler Health Education Library in the Bretholtz Center where patients and families can access computers and knowledgeable staff.

Access a complete directory of patient and family services.

Visit the Brigham and Women’s Hospital HealthHub Blog, which features information on a variety of topics, including aneurysms.

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