This page contains the following sections:
When is surgical repair of an aortic aneurysm advisable?
How is repair of an aortic aneurysm accomplished?
What are the risks and benefits of such surgery?
What is involved in a typical recovery?
When is surgical repair of an aortic aneurysm advisable?
If an aortic aneurysm—a bulge in the wall of your body's main artery—is larger than 2 inches (or 5.0 to 5.5 centimeters) in diameter, is growing fast, or is causing serious symptoms (such as pain or trouble breathing), it is advisable to consider the possibility of surgical repair.
If you are diagnosed with an aneurysm, 你的外科医生会评估你的具体情况，并帮助你权衡心脏手术的风险与继续用药物和其他非手术治疗来控制疾病的风险. 如果你的动脉瘤和它的症状还没有达到需要手术的程度, you can enroll in our comprehensive, multidisciplinary aneurysm follow-up clinic; this will provide you with regular imaging of your aneurysm and assessment of your health status.
Should you and your surgeon decide the time is right for surgical repair, 请记住，我们的心脏外科医生在所有经过验证的手术修复动脉瘤的选择方面都有相当的专业知识.
How is repair of an aortic aneurysm accomplished?
有许多方法可以修复或替换被动脉瘤损坏的主动脉部分. 使用哪种方法取决于动脉瘤的位置(是否在你的 ascending aorta or aortic arch, for example, or in your descending aorta), how big it is, and the overall state of your health. 你的外科医生会根据你的具体情况决定以下哪一种手术是最合适的:
- Open-heart surgery 修复主动脉瘤需要在胸骨中间做一个7到10英寸的切口, or breastbone, then dividing the sternum to allow access to the heart. 在某些情况下，可能采用侵入性较小的选择，包括稍小的胸骨切口. In either case, 实际的修复包括用一根和你的主动脉一样大小的管子来代替你的主动脉受损部分, made of a durable artificial material such as Dacron, which is sutured, or sewn, into place.
It will be necessary to stop your heart from beating during the procedure, so the operation can be performed on a motionless and bloodless field; while your heart is stopped, 一种被称为心肺旁路机的设备将接管你的心脏功能并维持血液循环. Very occasionally, during complex operations involving replacement of a portion of the aorta, you may also be put into a state known as hypothermic circulatory arrest; this involves lowering your body temperature to significantly slow your body's cellular activity, permitting your blood flow to be temporarily stopped. (The term "hypothermic" comes from Greek words meaning "low heat," while "circulatory arrest" means your circulation is arrested, or stopped.) In other cases, a technique known as axillary cannulation (or the insertion of a drainage tube, known as a cannula, in an artery in your armpit, or axilla) can allow aortic replacement to be performed without hypothermic circulatory arrest; this advance may reduce the incidence of postoperative strokes and neurological deficits.
- Endovascular surgery may be an option for some patients. This minimally invasive procedure involves making a couple of tiny incisions (often just 1 to 2 inches) 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, 细的器械穿过导管，在血管受影响的部分放置一个被称为支架的小网状管. (The term "endovascular" comes from Greek and Latin words meaning "within a vessel.")
In circumstances when it is appropriate, endovascular surgery can sometimes be done with the patient under local rather than general anesthesia; in addition, 它通常不需要低温循环停搏或使用心肺旁路机. Since this approach avoids the need to open the chest at all, it usually results in much faster healing.
- Valve-sparing surgery 是否可以考虑在离心脏最近的主动脉根部进行手术. This procedure involves replacement of just the damaged portion of the vessel, not of the aortic valve as well; it is thus appropriate only for patients whose aortic valve is intact or repairable. The alternative is known as a composite graft, and it involves not only replacing the affected portion of the aorta but also replacing the aortic valve with a mechanical valve.
What are the risks and benefits of such surgery?
重要的是要记住，每一个医疗选择都涉及风险和收益之间的权衡——无论是接受手术, take medication, or even just carefully monitor a condition (an option known as "watchful waiting").
In the case of an aortic aneurysm, if you meet the criteria above (that is, your aneurysm is larger than 2 inches, growing fast or causing serious symptoms), 决定手术是否明智，需要权衡任何心脏手术所涉及的风险与动脉瘤破裂可能性的增加, or burst. Your risk of dying if you suffer a ruptured aortic aneurysm is between 50% and 75%.
The risks involved in surgery are far lower. A given patient's risk will vary, depending on such factors as age and overall health status, but the average mortality, or risk of death, from repair of an aortic aneurysm is about 5%. 动脉瘤修复手术也有3%到5%的血栓风险，血栓会导致严重的中风. 而且任何外科手术都有很小的并发症风险，比如感染.
吸烟的患者如果在手术前至少2至4周戒烟(最好不要在心脏手术前立即戒烟)，可以降低并发症的风险, however, because when people stop smoking they often have short-term bronchorrhea, or excess secretions in their respiratory tract, 这让他们经常咳嗽——当你刚做过心脏手术时，经常咳嗽不是一个好主意。).
The benefits of a successful repair are considerable. 绝大多数接受主动脉瘤修复的病人, once they recover, feel better than they did before the operation, are able to breathe far better, and are able to resume any activities they wish to engage in.
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, 然后可以移除胸腔中的引流管，当天晚些时候可以将他们转移到普通的医院病床上.
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, 虽然大约15%到20%的人可能需要在康复机构花一些时间进行更广泛的康复. After discharge, 建议患者在三周内不要开车，在六周内不要举起超过5磅的东西. 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, 手术时间和恢复期通常都较短(血管内手术时间更短)。.
Page reviewed on: Jun 26, 2018
Page reviewed by: Jock McCullough, MD