Aneurysm Treatment Surgery

What is an Aneurysm?

An artery is a blood vessel that carries oxygen-rich blood from your heart to all the parts of the body. An aneurysm is a condition where the walls of the artery dilate or “balloon” out. This ballooning may increase in size and finally burst leading to life threatening bleeding or the artery blocking off.

There are three main types of aneurysms we treat at Ponosh Vascular are :

  1. Abdominal Aortic Aneurysms – the commonest aneurysm found in the largest artery of your body, the aorta, in your abdomen (belly)
  2. Thoracic Aortic Aneurysms – an aneurysm found in the largest artery of your body, the aorta, in your chest
  3. Peripheral Artery Aneurysms – aneurysms found in other arteries of your body such as in the popliteal artery being your knee

Have Questions or Need Help?

Contact our friendly team for a referral and enjoy personalized, attentive care. Your comfort and health is our priority.
Call: 08 9386 6200 or Email: admin@ponoshvascular.com.au

Seeing Mr Ponosh

If you suspect you have an aneurysm, make an appointment with your GP, however in most cases aneurysms have NO symptoms or signs. In most cases your GP will find an aneurysm incidentally while looking for other conditions. Your GP may contact Mr Ponosh’s office directly or, they may provide you a referral to contact his office yourself where his caring staff will help you make an appointment. For further information regarding referrals, click here.

At your appointment with Dr Ponosh, he will undertake a full history and appropriate examination. He may also order appropriate tests before he sees you, to streamline your management and avoid unnecessary appointments. If possible, these tests are bulk billed and they may include ultrasounds, CT scans or blood tests.

From your appointment and tests, Mr Ponosh will develop an appropriate aneurysm treatment plan. This may simply be a regular check-ups and observation or in some cases may be the definitive repair of the aneurysm. In most cases this is achieved through a minimally invasive keyhole stent repair known as an endocascular aneurysm repair.

He will explain the plan to you in an open, straightforward manner with all options and questions addressed.

If you have any questions, please do not hesitate to contact our friendly team on (08) 9386 6200.

 

Thoracic Aortic Aneurysms (TAA)

An aneurysm in the aorta (major artery arising from the heart) that runs down your chest.

Read More about TAA treatment and repair. [Expandable Content]

TAA’s are a progressive dilation of the aorta. Most aneurysms start and stay small with the normal male aorta measuring 15-17mm however, they can progressively dilate over time. They are of concern when they approach 60mm or demonstrate more rapid patterns of growth in many instances.

Most aneurysms are found by accident, usually during the investigation of other complaints.

What Causes a Thoracic Aortic Aneurysm?

The cause of a TAA is not well known however, there are numerous risk factors that include:

  • Family history of aneurysm
  • Being male
  • Being over 60
  • A history of smoking
  • High blood pressure
  • High cholesterol
  • Atherosclerosis (hardened arteries)
  • Having a connective tissue disorder like Marfan syndrome or Ehlers-Danlos syndrome

If you are known to have, or if you are likely to develop an aneurysm disease, it is recommended that you optimise your lifestyle by:

  • Controlling high blood pressure
  • Controlling cholesterol
  • Ceasing smoking
  • Exercising regularly

Thoracic Aortic Aneurysm Treatment

 In most cases, small aneurysms have minimal or no symptoms and are completely safe and should not worry you. These stable or slowly growing aneurysms simply need a regular check up with an ultrasound or CT scan with your vascular surgeon to ensure they remain safe.

Treatment may never be needed but if it is required, close surveillance allows safe and effective aneurysm treatment at the right time avoiding the severe complications they occasionally pose.

As they grow, often over a period of years, the walls may thin as the aneurysm balloons to a point that it may leak or rupture. This in most cases is associated with aneurysms in excess of 60mm. This is a life-threatening complication and is associated with severe internal bleeding and clots. More easily manageable, or smaller aneurysms simply need lifestyle changes, a watchful eye and regular checkups with your vascular surgeon.

What Happens if I Think I Have a TAA

Most aneurysms are found by accident during other tests. Your GP may then send you to see Mr Ponosh directly. If you think you are at risk of having an aneurysm OR have a family history of aneurysm you should:

See your GP: Your GP will assess you and may organise an ultrasound scan. If evidence presents of a TAA your GP will almost always send you onto a Vascular Surgeon, such as Mr Ponosh.

If you know you have a TAA that is under surveillance or observation by Mr Ponosh (ie; it is asymptomatic and smaller than the treatment cut-off size), you would normally have a non-invasive ultrasound at a specialised vascular ultrasound practice on a regular basis and be observed every 6-12 months by Mr Ponosh.

If your TAA reaches a size of approximately 60mm or demonstrates a period of rapid growth, Mr Ponosh may suggest consideration for treatment. A CT scan is usually arranged at this time for more accurate assessment of your aneurysm and its anatomy.

How are TAA’s Repaired?

Mr Ponosh will keep a very close eye on your TAA. When it reaches an appropriate size, it may be considered for repair. This not only depends on the size of the TAA but also on its location, anatomy, your age and your general health.

Ongoing Observation:

If you have very complicated aneurysmal anatomy, especially if the aneurysm is very close to other main arteries (arm, brain or bowel), due to the increased complexity of the repair options and the risk this imposes, Mr Ponosh may suggest maintaining close observation until the TAA reaches a larger size. At this point the risk of repair is more appropriate to the risk of the aneurysm. Also, if your general health is poor, Mr Ponosh may also suggest ongoing observation rather than repair due to the risks to your life and lifestyle.

Endovascular Repair (EVAR):

If repair of your TAA is recommended, in the majority of cases Mr Ponosh will recommend an endovascular or “keyhole repair”. In most cases this is a very straight forward and uncomplicated procedure. This aneurysm treatment surgery has been proven to be a very effective and durable repair using special “stents” to seal the aneurysm.

This procedure is usually conducted under a general or spinal anaesthetic, where Mr Ponosh makes a very small incision (5mm) in the groin region and guides a catheter (thin tube) through the blood vessel. He then uses live X-ray images to guide a stent-graft to the site of the aneurysm. The graft re-lines the aorta, sealing the aneurysm and prevents it from rupturing. It takes in most cases approximately 60 minutes. You may be required to stay in hospital for 2-3 days until recovery. In time, the aneurysm may even shrink because of the stent-graft.

In some cases, a more complicated EVAR known as a Fenestrated Endovascular Repair (FEVAR) is undertaken. This is usually in cases where the aneurysm is close to other important arteries. This requires a custom-made, hand sown stent that seals above these important arteries. This custom-made graft has small holes (fenestrations) which are carefully lined up with important arteries, through which additional stents are placed from the main graft to seal the aneurysm. This may take 3-4 hours in more complicated cases and is a riskier procedure.

Open Surgical Repair of TAA

This is the traditional repair method for aneurysms and is rarely undertaken. Surgical repair is usually reserved for cases that are not suitable for EVAR or FEVAR, are urgent and cannot wait for custom-made grafts, or occasionally in young patients.

This aneurysm treatment surgery is a more involved procedure undertaken through a long cut in your chest in which a new plastic tube is hand stitched in place. It takes several hours to complete, has a hospital stay of 10-14 days and a recovery of several weeks.

 

Abdominal Aortic Aneurysm

An AAA is aneurysm located in the aorta that extends to your abdominal region and are the most common form of aneurysms we see.

Read More about AAA treatment and repair.

AAA’s are a progressive dilation of the aorta and are usually found by accident when investigating other complaints. Most aneurysms start and stay small with the normal male aorta measuring 15-17mm and in some cases over time will progressively dilate. They are of concern when they approach 50mm or demonstrate more rapid patterns of growth in many instances.

What Causes an Abdominal Aortic Aneurysm?

The cause of aneurysm is not well known, but there are numerous risk factors that include:

  • Family history of aneurysm
  • Being male
  • Being over 60
  • A history of smoking
  • High blood pressure
  • High cholesterol
  • Atherosclerosis (hardened arteries)
  • Having a connective tissue disorder like Marfan syndrome or Ehlers-Danlos syndrome

If you are known to have, or if you are likely to develop an aneurysmal disease, it is recommended that you improve your lifestyle by:

  • Controlling high blood pressure
  • Controlling cholesterol
  • Ceasing smoking
  • Exercising regularly

What do AAA’s do?

In most cases, small AAA’s are completely safe and should not worry you and have minimal or no symptoms. These aneurysms are stable or growing slowly and simply require regular checkups with an ultrasound or CT scan with your vascular surgeon to ensure they remain safe.

Aneurysm treatment surgery may never be needed but if it is, close surveillance allows safe and effective treatment at the right time avoiding the severe complications that aneurysms can occasionally pose.

As they grow often over a period of years, the walls may thin as the aneurysm balloons to a point that the aneurysm may leak or rupture. This in most cases is associated with aneurysms in excess of 50mm. At this stage it is a life-threatening complication and is associated with severe internal bleeding and clots. More easily manageable, or smaller aneurysms simply need lifestyle changes, a watchful eye and regular checkups with your vascular surgeon.

What Happens if I Think I Have an AAA

Most aneurysms are found by accident during other tests and your GP may then send you to see Mr Ponosh directly.

If you think you are at risk of having an aneurysm OR have a family history of aneurysm you should:

See your GP: Your GP will assess you organise any ultrasound scans if required. If evidence presents of an AAA, your GP will most likely send you onto a Vascular Surgeon, such as Mr Ponosh.

If you know you have an AAA, which is under surveillance, or observation by Mr Ponosh (ie; it is asymptomatic and smaller than the treatment cut-off size), you would normally have a non-invasive ultrasound at a specialised vascular ultrasound practice on a regular basis and be observed every 6-12 months by Mr Ponosh.

If your AAA reaches a size of approximately 50mm or demonstrates a period of rapid growth, Mr Ponosh may suggest consideration for treatment. A CT scan is usually arranged at this time for more accurate assessment of your aneurysm and its anatomy.

How are AAA’s Repaired?

Mr Ponosh will keep a very close eye on your AAA. When it reaches an appropriate size, it may be considered for treatment surgery or repair. This not only depends on the size of the AAA but also on its location, anatomy, your age and your general health.

Ongoing Observation

If you have very complicated aneurysmal anatomy, especially if the AAA is very close to other main arteries (kidney or bowel), due to the increased complexity of the repair options and the risk this imposes, Mr Ponosh may prefer to maintain close observation until the aneurysm reaches a larger size. At this point the risk of repair is more appropriate to the risk of the aneurysm. Also, if your general health is poor, Mr Ponosh may suggest ongoing observation rather than repair due to the risks to your life and lifestyle.

Endovascular Repair (EVAR)

Where repair of your AAA is recommended Mr Ponosh will mostly recommend an endovascular or “keyhole repair”. This is a very straightforward and generally uncomplicated procedure which has proven to be a very effective and durable repair using special “stents” to seal the aneurysm. This procedure is usually performed under a general or spinal anaesthetic where a very small incision (5mm) is made in the groin region and a catheter (thin tube) is guided through the blood vessel. Mr Ponosh then uses live X-ray images to guide a stent-graft to the site of the aneurysm. The graft re-lines the aorta, sealing the aneurysm and prevents it from rupturing. In most cases the procedure takes approximately 60 minutes and you may be required to stay in hospital for 2-3 days until recovery. In time, the aneurysm may even shrink because of the stent-graft.

In some cases, a more complicated EVAR known as a Fenestrated Endovascular Repair (FEVAR) is undertaken. This usually occurs when the aneurysm is close to other important arteries such as the kidney or bowel. This procedure requires a custom-made, hand-sown stent that seals above these important arteries. This custom-made graft has small holes (fenestrations) that are carefully lined up with important arteries, through which additional stents are placed from the main graft to seal the aneurysm. This may take 3-4 hours in more complicated cases and is a riskier procedure.

Open Surgical Repair of AAA

Open surgery is the traditional repair treatment method for aneurysms. This type of repair is only undertaken in 5-10% cases and is usually reserved for cases that are not suitable for EVAR or FEVAR, are urgent and cannot wait for custom made grafts, or occasionally in young patients.

It is a more involved procedure undertaken through a long cut in your abdomen in which a new plastic tube is hand stitched in place by Mr Ponosh. It takes several hours to complete, has a hospital stay of 10-14 days and takes several weeks to recover from.

 

This is an aneurysm in the arteries found in peripheral regions such as the popliteal artery, which runs down the back of your lower knee and thigh and, the femoral artery which is found in the groin area.

What Causes an Aneurysm?

Degeneration or the process of aging on the wall of the artery causes most aneurysms. The strength of arteries is associated with collagen and elastin, the same structures that give our skin elasticity. As time goes on, these structures degenerate or breakdown causing weakness of the artery that can cause it to balloon. In some cases, they can be caused by inflammation, which leads to the weakening or breakdown of the artery walls. This inflammation can result from atherosclerosis, which is characterized by the deposition of plaque (calcium, cholesterol and minerals). These plaque deposits weaken the inner wall of the artery, making it more susceptible to swelling and rupture.

In some rare instances, diseases like Marfan’s syndrome (a genetic disorder that affects the tissues holding the body’s cells, tissues and organs together) can cause aneurysms as well as trauma or a variety of much rarer causes.

Who is Susceptible to Aneurysms?

The most common group of people who are susceptible to aneurysms is males over the age of 60 with a history of smoking. A family history may also occasionally be involved.

What are the Symptoms of an Aneurysm?

Most aneurysms may not show any symptoms however, when symptoms do appear, they generally depend on the region of the aneurysm.

Symptoms for a thoracic aortic aneurysm may rarely include:

  • A pulsatile lump in your abdomen
  • Rarely, your feet may develop painful sores and discoloration
  • Mild back or abdominal pain
  • Extremely rarely, severe abdominal or back pain or collapse

General Risks of Aneurysm Treatment & Repair

Mr Ponosh will spend a lot of time discussing aneurysm treatment and repair with you in detail. He will cover all the potential associated risks in an easy to understand, reassuring manner. The risks of aneurysm treatment and surgery can include:

  • Heart complications
  • Lung complications
  • Kidney complications and damage
  • Bleeding at the site of repair and/or access
  • False aneurysm
  • Pain/Discomfort
  • Damage to blood vessels
  • Nerve effects (including those that can cause sexual dysfunction in males)
  • Failure of technique and conversion to alternative approach
  • Blood clots (DVT/PE)
  • Infection
  • Infection of the stent graft used for the aneurysm repair
  • Multiple organ failure (MOF), which can be fatal

While the risks of aneurysm treatment surgery can be severe, the risk of not treating the aneurysm can be worse. Mr Ponosh will be able to provide you with the information you need to make an informed decision.