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Treatments and drugs
By Mayo Clinic staff
The goal of treatment is to prevent your aneurysm from rupturing. Generally, your treatment options are to watch and wait or to have surgery. Your decision depends on the size of the aortic aneurysm and how fast it's growing. Here are the general guidelines for treating abdominal aortic aneurysms:
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Small aneurysm. If you have a small aortic abdominal aneurysm — about 1.6 inches, or 4 centimeters (cm), in diameter or smaller — and you have no symptoms, your doctor may suggest a watch-and-wait (observation) approach, rather than surgery. In general, surgery isn't needed for small aneurysms because the risk of surgery outweighs the risk of rupture.
If you choose this approach, your doctor will monitor your aneurysm with periodic ultrasounds, usually every six to 12 months and encourage you to report immediately if you start having abdominal tenderness or back pain — potential signs of a dissection or rupture.
- Medium aneurysm. A medium aneurysm measures between 1.6 and 2.2 inches (4 and 5.5 cm). It's less clear how the risks of surgery versus waiting stack up in the case of a medium-size aortic abdominal aneurysm. You'll need to discuss the benefits and risks of waiting versus surgery and make a decision with your doctor.
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Large or fast-growing aneurysm. If you have an aneurysm that is large (larger than 2.2 inches, or 5.5 cm) or growing rapidly (more than 0.5 cm over six months), leaking, tender or painful, you'll probably need surgery. Surgery to repair an aortic aneurysm involves removing the damaged section of the aorta and replacing it with a synthetic tube (graft), which is sewn into place. This procedure requires open-abdominal or open-chest surgery, and it will take you several months to fully recover.
It's also possible you could have a less invasive procedure called endovascular surgery to repair your aneurysm. Doctors attach a synthetic graft to the end of a thin tube (catheter) that's inserted through an artery in your leg and threaded up into your aorta. The graft — a woven tube covered by a metal mesh support — is placed at the site of the aneurysm and fastened in place with small hooks or pins. The graft reinforces the weakened section of the aorta to prevent rupture of the aneurysm.
Recovery time for people who have endovascular surgery is shorter than for people who have open-chest or abdominal surgery - about one or two weeks compared with six weeks with open surgery. Research has shown that people who have endovascular surgery also have lower rates of death and complications due to their aneurysms.
Thoracic aortic aneurysm treatment
If you have a thoracic aortic aneurysm, surgery is generally recommended if your aneurysm is 2.2 inches (5.5 cm) and larger. If you have Marfan syndrome or a family history of aortic dissection, your doctor may recommend surgery for smaller aneurysms, as well.
For people who have Marfan syndrome, medications called beta blockers have been shown to slow the growth of thoracic aortic aneurysms.
Emergency surgery
Although it's possible to repair a ruptured aortic aneurysm with emergency surgery, the risk is much higher and there is less chance of survival. Many people who experience a ruptured aortic aneurysm die before they reach the hospital.
Recommendations for surgical treatment of thoracic aortic aneurysms depend on whether you have another condition, such as Marfan syndrome, and location of the aneurysm.
