Tuesday, April 9, 2024

Aortic Aneurysm Surgery Survival Rate

Risks Of Preventive Surgery

Better Survival with Endovascular Repair of AAA

Surgery on an aneurysm can lead to serious complications, especially lung complications and damage to the heart. It may even lead to death, for example due to circulatory collapse. The risk of complications is determined by various factors. One of these is the patients general health. For instance, people who have cardiovascular disease have a higher risk. Sometimes further surgery is needed right after surgery or at a later date.

So doctors estimate the patients risk of complications. Reasons not to have preventive surgery include the following:

  • The person has other serious conditions, such as heart disease.
  • The person’s general health is so poor that a procedure seems to be too risky, for example due to old age and the associated problems.

Surgery is considered if the risk of the aneurysm unexpectedly rupturing in the next few years seems to outweigh the risks associated with the surgery.

Causes And Risk Factors

Its still not well understood why some people develop an aortic aneurysm while others dont. Different factors may increase your risk, including:

Heart disease: The most common cause of aortic aneurysms is atherosclerosis, also known as hardening of the arteries. Youre also at higher risk of an ascending aortic aneurysm if you have aortic valve disease. The aortic valve releases blood from the heart into the aorta. Most people have an aortic valve with three flaps or leaflets that open and close with each heartbeat. If you were born with a bicuspid valve , you have a higher risk of an ascending aortic aneurysm.

Older age: An ascending aortic aneurysm usually forms in people in their 60s and 70s.

Family history: About 20 percent of all thoracic aneurysms develop in people with a family history of thoracic aneurysms. These cases tend to develop in younger people.

Genetics: Certain inherited conditions are linked to a higher risk of ascending aortic aneurysms, including:

These are called connective tissue disorders, and they can lead to many complications in addition to aortic aneurysms.

Infection: Sometimes, certain infections can also weaken artery walls, including those in the aortic arch. These infections include syphilis and salmonella.

Comparison Of Counts With Nvr

The UK National Vascular Registry is a dataset of vascular procedures performed by vascular surgeons the information is uploaded voluntarily by vascular specialists and include details of the procedure, information specific to the patient as well as the disease . The annual cases of infra-renal AA elective repairs from HES as identified by the methods described in this paper were compared to the numbers reported by NVR. This group was chosen since it was the only case-mix group consistently reported from 2009 to 2013 . To allow comparability with the NVR cases, all AA operations for each patient within the calendar, rather than financial year, were identified. Table shows the comparison between the numbers of elective infra-renal repair cases from HES data and the numbers reported by NVR.

Table 6 Comparison of elective infra-renal AA repairs from HES and NVR

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What Procedures And Tests Diagnose Aortic Aneurysms

Most aortic aneurysms cause no symptoms and are found when a person undergoes a medical test or procedure for some other reason. Others are found only when the individual has symptoms .

The typical symptoms of an abdominal aortic aneurysm are not specific. This means that they could be caused by a number of different conditions.

  • The doctor will probably not know at first what is causing symptoms. He or she will rapidly consider the possibilities and develop a plan for systematically ruling each one out.
  • This evaluation will start with the most serious conditions, and ruptured aneurysm is near the top of the list.
  • If the person is able, they can help by giving a focused, detailed description of how the symptoms started, how they were feeling before the symptoms started, and how the situation once the symptoms started. Because some patients cannot communicate or remember items, it is helpful to arrive in an emergency department with someone who knows or who has access to the patient’s medical and surgical history. This is especially helpful if the patient has a documented history of an aortic aneurysm or conditions that might predispose them to aneurysms .

A full exam, with special attention to the cardiovascular system and abdomen, will give clues to the diagnosis.

  • The doctor may be able to feel a pulsating bulge in the abdomen or hear a loud pulse or other signs of aortic enlargement with the stethoscope.
  • The exam findings will guide the rest of the evaluation.

What Is The Anatomy Of My Aortic Root

Abdominal Aortic Aneurysm: Has the Bubble Burst?

Your aortic root is the first part of your aorta that attaches to your heart. Your aorta is the largest artery in your body. Its shaped like a shepherds crook. The handle curves upward out of your heart. Your aortic root is the very start of the handle. Its connected to your heart by a tough, fibrous ring called the aortic annulus .

Your aortic root gives rise to your ascending aorta. This is the upward curve of the handle. Some aneurysms affect both your aortic root and your ascending aorta. Your ascending aorta leads up to your aortic arch, which is the peak of the curve. Your descending aorta is the part after the arch, which you can picture as the straight stick of the shepherds crook. It travels down through your chest and leads to your abdominal aorta .

The aortic root contains your aortic valve. Its also where your coronary arteries begin. Your surgeon may mention your aortic sinuses . These are gentle bulges in your aortic root that give rise to your coronary arteries.

All parts of your aortic root are elastic and flexible when youre a child. But they become less flexible as you get older. This loss of elasticity affects how they move and how well your aorta can function.

Because your aortic root is so complex, surgery on it is also complex. But in skilled and experienced hands, your aortic root can be made healthy again.

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Sample And Data Collection

We included all patients who underwent elective replacement of an ascending aortic aneurysm at our institution between 2000 and 2019. Concomitant aortic valve or coronary surgeries were allowed. Aortic valve-sparing, Bentall-Bonno procedures and all surgeries on the aortic root or the aortic arch were included if the ascending aorta was also replaced.

Patients were excluded if they underwent a previous surgery on the ascending aorta or the aortic root. Patients with acute aortic syndrome, chronic dissections, pseudoaneurysms or those who required concomitant mitral or tricuspid valve surgery were also excluded.

All data relating to the pre-, intra-, and postoperative periods were collected retrospectively from a digital database completed prospectively by the patients surgeon. The postoperative period was taken as the first 30 days of follow-up, or until the date of hospital discharge if this was beyond 30 days.

Data on death during follow-up were collected by one of the researchers who analysed the information in the medical records from all the health centres and hospitals of our Region. All hospitals and health centres of our region are connected via intranet so, from our institution, we could investigate all medical records and health reports.

Aneurysm Diameters At Baseline And Growth Over Time

The largest aneurysm was in the DTA for 636 ITT patients and 89 CM patients. Mean maximum diameter at baseline was 5.6 cm in ITT patients and 6.3 cm in CM patients. After excluding scans using techniques other than CT or MRI and one scan dated 20 years before ETTAA, 1767 scans in 882 patients were included. Times between first and subsequent scans ranged from 3 days to 7.35 years.

The final model describing diameter measurement trajectories in the absence of treatment is shown in . Average diameter in the DTA at baseline for a person of average age, with no comorbidities was 5.57 cm . At first scan, larger aneurysms were found for older patients , connective tissue disorders , and COPD . At baseline, adjusting for age, scan type, and comorbidities, the mean difference between maximum diameter in upper and lower sections of the thoracic aorta was small .

Estimated mean aneurysm diameter over time by site of maximum measurement.

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What Is Aortic Root Replacement Surgery

Aortic root replacement surgery fixes an aneurysm in the part of your aorta that attaches to your heart. An aneurysm is a weak spot in a blood vessel wall. Aneurysms can dissect or rupture and cause life-threatening internal bleeding. Aneurysm surgery can save your life by preventing rupture or dissection.

Aortic root replacement surgery may replace both your aortic root and your aortic valve. Or, it may replace your aortic root but leave your valve. The type of surgery you have depends on many factors including the health of your aortic valve.

Here Are A Few To Consider

Natural History of Thoracic Aortic Aneurysm

An aortic aneurysm is a bulge in the aorta, the largest blood vessel in the body. Aneurysms can form in the chest or abdomen . Sixty percent of aortic aneurysms involve the part of the aorta that extends immediately from the heart. Forty percent occur in the segment extending into the abdomen. The larger the aneurysm grows, the greater the chance it may dissect or rupture, which is life-threatening.

Abdominal aortic aneurysms , or aneurysms in the abdominal part of the aorta, are the 13th leading cause of death in the United States and the 10th leading cause of death in men.

NewYork-Presbyterians aortic surgeons had a 100% success rate in treating abdominal aneurysms involving the arteries of the kidneys .

This success has become possible through the creation of a comprehensive Aortic Center at NewYork-Presbyterian/Columbia University Medical Center. This integrated program, directed jointly by cardiac and vascular surgeons in the Department of Surgery, features a 24/7 on-call team of cardiologists, vascular surgeons, cardiac surgeons, and interventionalists who specialize in the treatment of aortic aneurysms and dissections. This team is carefully coordinated by Tracy Andrews, DNP, ACNP, a highly experienced cardiac surgical nurse practitioner, who rapidly assesses incoming patients, obtains critical test results, and directs patients to the appropriate specialists for treatment.

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How Is Repair Of An Aortic Aneurysm Accomplished

There are a number of ways to repair or replace the portion of an aorta damaged by an aneurysm. Which option is used will depend on such factors as where your aneurysm is located , how big it is, and the overall state of your health. Your surgeon will determine which of the following procedures is most appropriate in your particular situation:

  • Endovascular surgery may be an option for some patients. This minimally invasive procedure involves making a couple of tiny incisions in blood vessels in your groin inserting long, thin tubes known as a catheters through the vessels to the point where your aneurysm is located and then using X-ray guidance and long, thin instruments threaded through the catheters to place a little mesh tube known as a stent graft inside the affected portion of the vessel. In circumstances when it is appropriate, endovascular surgery can sometimes be done with the patient under local rather than general anesthesia in addition, it usually does not require hypothermic circulatory arrest or use of a heart-lung bypass machine. Since this approach avoids the need to open the chest at all, it usually results in much faster healing.

Proteolysis Metalloproteinases And Inflammation

In AAA, the aortic media appears to degrade by way of a proteolytic process. This implies an increase in the concentration of proteolytic enzymes relative to the concentration of their inhibitors in the abdominal aorta as the individual ages.

Some research has focused on the role of the metalloproteinases, a group of zinc-dependent enzymes responsible for tissue remodeling. Reports have documented increased expression and activity of matrix metalloproteinases in people with AAAs. MMPs and other proteases have been shown to be secreted into the extracellular matrix of AAAs by macrophages and aortic smooth-muscle cells.

MMPs and their inhibitors are present in normal aortic tissue and are responsible for vessel-wall remodeling. Aneurysmal tissue tends to demonstrate increased MMP activity and decreased inhibitor activity, which favor the degradation of elastin and collagen. The mechanism that tips the balance in favor of degradation of elastin and collagen in the aortic wall of AAAs by MMPs and other proteases is not yet known.

Upon histologic examination, AAAs demonstrate a chronic adventitial and medial inflammatory infiltrate. Infiltration of AAAs with lymphocytes and macrophages may trigger protease activation via various cytokines .

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What Happens During Thoracic Aortic Aneurysm Surgery

In open thoracic aortic aneurysm repair, your surgeon:

  • Makes a large incision along the side of your chest.
  • Uses special tools to stop blood flow temporarily in the affected segment of your aorta.
  • Replaces the damaged section of your aorta with a synthetic graft.
  • Closes the incision with stitches.
  • During TEVAR, your provider:

  • Inserts a catheter and special wires through an artery in your groin.
  • Guides the catheter to your thoracic aorta.
  • Injects a contrast dye through the catheter so they can see your thoracic aorta clearly.
  • Uses CT or X-ray guidance to position the stent accurately.
  • Removes the catheter and wires and places a bandage over the incision area in your groin.
  • How Long Does An Aortic Root Replacement Last

    Screening men for abdominal aortic aneurysm: 10 year mortality and cost ...

    Aortic root replacement is a durable and long-term solution for aortic root aneurysms. How long the valve lasts depends on the type of valve you receive. Mechanical valves last for the rest of your life, but you need to take blood thinners. Biologic valves last at least 10 years in most people but then may need to be replaced.

    If you have VSRR, your natural aortic valve may last the rest of your life. But you may need another surgery at some point to get a new valve. It depends on your anatomy and other medical conditions.

    Before your surgery, youll have pre-operative imaging tests. These tests will help your surgeon predict the durability of your specific surgery. Talk with your surgeon before surgery and make sure you understand your long-term outlook.

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    Operation For Aneurysm Yields Nearly Normal Longevity

    American Heart Association
    For patients undergoing repair of intact abdominal aortic aneurysms, long-term survival has improved in recent decades. For patients undergoing repair of ruptured abdominal aortic aneurysms, short-term survival has improved and long-term survival has remained stable. A less invasive procedure, endovascular aneurysm repair, is allowing surgical repair for older people with additional health problems.

    Long-term survival for patients undergoing surgical repair of intact abdominal aortic aneurysms has improved in recent decades, according to a Swedish study reported in Circulation: Journal of the American Heart Association.

    An abdominal aortic aneurysm is a bulge in the main artery leading away from the heart that occurs below the kidneys . If such a bulge bursts, hemorrhaging can occur within the abdominal cavity. These aneurysms can be monitored or corrected surgically while the bulge is intact, but require emergency surgery when ruptured.

    In the new study, researchers examined patient outcomes of 8,663 operations to repair intact aneurysms and 4,171 to repair ruptured ones from 1987 to 2005. The researchers used the patients’ relative five-year survival rate as a key measure. That rate excluded patients who died within 90 days of surgery and was based on a comparison of expected survival rates in a broader population with the same demographic characteristics.

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    What Are The Chances Of Surviving An Aortic Aneurysm

    Previously, due to lack of proper medical facilities, the survival rate of an aortic aneurysm was quite low making it a fatal disease. Nowadays, with the medical advancement the survival rates of the patients with aortic aneurysm have improved considerably. The relative rate of survival has gone up to 87 percent. Although early detection may increase the chances of survival, it is seen that the patients who have undergone surgery for a ruptured aortic aneurysm lived on an average of five years post-surgery.

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    What Is Involved In A Typical Recovery

    A typical open-heart procedure takes from 4 to 6 hours, in some cases up to 8 hours patients are then maintained under general anesthesia for an additional 4 to 6 hours. If their wound is healing well and there is no excess bleeding, they can emerge from anesthesia and have their breathing tube removed. Most patients stay in the ICU until midday of the day after their procedure if they continue to do well, the drainage tubes in their chest can then be removed and they can be moved to a regular hospital bed later that day.

    The typical hospital stay ranges from 7 to 10 days, in some cases up to 14 days. At that point, the vast majority of patients are able to go home, with support from the visiting nurse service, though about 15% to 20% may need to spend some time in a rehab facility for more extensive rehabilitation. After discharge, patients are advised not to drive for about three weeks and not to lift anything heavier than 5 pounds for about 6 weeks. Beyond that point, they can resume whatever activities they wish to.

    Patients tend to be surprised at how easy it is to control their pain. By the second day after their operation, most patients are comfortable without intravenous pain medication, taking only oral painkillers, and the overwhelming majority are discharged home on just Tylenol or Motrin.

    In cases when minimally invasive surgery is appropriate, both the length of the operation and the recovery period are typically shorter .

    Page reviewed on: Jun 26, 2018

    What Is The Recovery Time After Thoracic Aortic Aneurysm Surgery

    EVAR for Ruptured Abdominal Aortic Aneurysm

    Most people are back to their usual routine within two to three months after thoracic aortic aneurysm surgery. Youll need to limit your physical activity for around four to six weeks after open surgery. You can return to daily activities within a couple of weeks after TEVAR, but youll still need to avoid strenuous activities for about four weeks.

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