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Aneurysm Repair with Closed Method


What is an aneurysm?



Aneurysm or ballooning is the loss of strength and enlargement of the vessel wall. In order to say that there is a ballooning, the normal diameter of that vessel must have increased at least 1.5 or 2 times. Vein diameters vary according to the age and gender of the person.



The main artery that carries the blood pumped to our body after leaving the heart is the 'aorta'. The aorta is called by different names during its course in our body. After leaving the heart, the 'ascending aorta' is known as the 'arch aorta' in the region where it gives the arm and neck arteries, the 'thoracic aorta' from the arm artery to the diaphragm, and the 'abdominal aorta' up to the level where it separates from the diaphragm to both leg arteries. Ballooning / aneurysms formed from any of these regions are also called by the same name. For example; such as abdominal aortic aneurysm, thoracic aortic aneurysm, ascending aortic aneurysm.



Aneurysm formation can be encountered in many parts of our body, for example, in large arteries such as the heart, brain, aorta, or in the arteries of the arms and legs, and in the arteries of our internal organs (such as spleen, kidney). They are most commonly located under the renal arteries (95%). The rest (5%) may be in different localizations above this level. It is more common in men than in women (approximately 4 times).



What are the symptoms?


Aneurysms may remain silent for many years and may not cause any complaints. They are usually diagnosed incidentally during examinations performed for different reasons. They create different complaints according to the regions they are in.



There may be abdominal pain in ballooning located in the abdomen or a continuous pain radiating towards the waist. Or, the diagnosis can be made with the examination performed as a result of the clot in the leg artery causing serious circulatory disorder in the leg. Sometimes the first finding may be rupture of the ballooning and severe shock. When patients put their hand on their stomach, they can feel the pulse beat with every beat of the heart. In very large bubbles, it can give the appearance of a moving mass that can be seen from the outside. Thoracic aneurysms may present with complaints of pain in the back, chest, cough, hoarseness or shortness of breath. Peripheral (arms and legs) aneurysms can also be seen with signs of pain, a mass moving with the heartbeat, circulatory disorder, color change over ballooning, and numbness due to nerve compression.



What are the causes of aneurysm?

Many factors play a role in the formation of aneurysm. But the vast majority (about 90%) are degenerative.

Arterial stiffness (Atherosclerosis)

smoking,

high blood pressure

Trauma

some infections

Having a family history (genetic factors)

Connective tissue diseases (Marfan syndrome)



How do we diagnose?

Most of the time, the presence of aneurysm in our patients is incidentally detected during the examination. Diagnosis is easily made with Ultrasonography, Computed Tomography and Magnetic Resonance Imaging (MR).



When should we treat?

When ballooning occurs in the vessel, the vessel wall becomes thinner and this leads to rupture of the vessel over time. Therefore, patients should be closely monitored. For minor ballooning, follow-up is recommended. In some special cases, it may be necessary to intervene in small-scale ballooning (if there is a rupture in the vessel and / or there is a high probability of rupture). If the vessel diameter has reached 5.5 cm, treatment is recommended. Computed Tomography and Ultrasonography can be used in the follow-up of the patients. With Computed Tomography, the growth and expansion rate of the ballooning is checked. Small-scale ballooning is followed at 6 or 12 month intervals. Ballooning that grows 0.5 cm in 6-month follow-ups or more than 1 cm in annual follow-ups, regardless of its diameter, should be intervened early.​



Which method?

Two different methods are used in the treatment of aortic aneurysms:

Open method (Surgical Treatment)

Closed Method (Endovascular Treatment)



In the open method, a large incision is surgically made in the area of ​​vasodilation (abdominal or thoracic cavity), the diseased vascular area is removed, and an artificial vein of suitable diameter is placed in the removed area.



Closed method or intravascular intervention (Endovascular Treatment) is a method that is performed with a 4-5 cm surgical incision in the inguinal artery region and is mostly applied under local anesthesia. With this incision, the inguinal artery is prepared and the grafts, called stent-grafts, are placed through the inguinal artery with the help of special guide wires - a carrier system, accompanied by angiography, and the diseased (aneurysm) area is deactivated.



What are the advantages of the Closed Method?

We can summarize it in a few items:



There is no or very little need to use blood and blood products (sometimes 4-5 Units of blood may be required to replace blood loss in the open method).

The procedure time is shorter than the open method..

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