Treatments
Determining Treatment
Treatment of peripheral aneurysms depends on:
- Presence of symptoms
- Size and location or the aneurysm
- Whether blood flow has been compromised by:
- Clotting of the aneurysm itself
- Blood clots that have broken loose from the aneurysm and lodged in downstream arteries, blocking their blood flow
Treatment Options
Conservative Management
In some circumstances, peripheral aneurysms are managed without surgery. This is especially true for very small aneurysms.
In such cases patients will return for visits periodically (once or twice a year) to monitor the aneurysm for enlargement and development of symptoms. Although nonsurgical management cannot "cure" an aneurysm, your physician will usually make recommendations given to all patients with atherosclerosis including:
- Control your risk factors by diet and lifestyle changes, especially stopping smoking
- Walk regularly to keep blood flowing in the legs
- Take care not to cross your legs or squat
- Clean your feet regularly and watch out for sores that don't heal
Open Surgical Aneurysm Repair
Aneurysms in the back of the knee or thigh (called popliteal aneurysms) that are larger than one inch in diameter usually require surgery.
Repair is usually done in an open, traditional fashion. Open surgery involves a major incision and general anesthesia is required.
Vascular surgeons usually treat peripheral aneurysms with a surgical bypass or replacement. During the operation, your vascular surgeon builds a new path for blood to flow through using a graft. This bypass graft may be made from a portion of one of your other veins or from a man-made tube formed from plastic or other materials. The bypass graft is connected above and below the aneurysm to allow blood to pass around the bulge. Such bypass surgery can require either general or local anesthesia. The operation typically requires a hospital stay of between two and seven days.
If a peripheral aneurysm is blocked by a clot, your doctor may administer a clot-busting drug, known as a thrombolitic agent, to dissolve the clot. This is done in preparation for the surgery. It may also be done at the time of angiography, if that test is ordered.
Endovascular Stent Graft Repair
Instead of suggesting traditional open surgery, your vascular surgeon may recommend a newer procedure called endovascular repair. The procedure is less invasive than traditional surgery.
Endovascular repair is relatively new, however, early results have compared favorably to conventional surgery. Because the long-term results are not yet known, it has been used most commonly in those patients in whom the risk of surgical repair is believed to be too high.
In the endovascular or minimally invasive approach, the procedure takes place inside the artery itself using small, thin tubes or catheters that are threaded through the blood vessels. The catheter is snaked into place through small incisions made in your groin. During the procedure, your surgeon will use live x-rays that are viewed on a video screen to guide placement of a metal and fabric tube, called an endovascular stent graft (or endograft), to the location of the aneurysm. The graft is secured by inflating a balloon to expand the graft to the size needed to prevent blood flow into the aneurysm. The stent graft both reinforces the weakened part of the vessel from the inside and creates a new channel through which the blood flows. This procedure reduces your hospital stay and recovery time.