Surgical Treatment of Aortic Aneurysms
The risk of the repair procedure is two-fold. First, there is consideration of the risk of problems occurring during and immediately after the procedure itself (“peri-procedural” complications). Second, the effectiveness of the procedure must be taken into account, namely whether the procedure effectively protects the patient from aneurysm rupture over the long-term, and whether the procedure is durable so that secondary procedures, with their attendant risks, are not necessary over the life of the patient. These issues attain importance and should be considered when making a choice between different treatment options. A less invasive procedure (such as endovascular aneurysm repair) may be associated with fewer short-term risks to the patient (fewer peri-procedural complications) but secondary procedures may be necessary over long-term follow-up.
The definitive treatment for an aortic aneurysm may be surgical or endovascular repair. The determination of surgical intervention is complex and determined on a per-case basis. Risk of aneurysm rupture is weighed against procedural risk. The diameter of the aneurysm, its rate of growth, the presence or absence of Marfan Syndrome, Ehlers–Danlos Syndrome or similar connective tissue disorders, and other co-morbidities are all important factors in the overall treatment.
A rapidly expanding aneurysm should under normal circumstances be operated on as soon as feasible, as it has a greater chance of rupture. Slowly expanding aortic aneurysms may be followed by routine diagnostic testing (i.e.: CT scan or ultrasound imaging).
For abdominal aneurysms, the current treatment guidelines for abdominal aortic aneurysms suggest elective surgical repair when the diameter of the aneurysm is greater than 5 cm (2 in).
Open surgery typically involves exposure of the dilated portion of the aorta and insertion of a synthetic (Dacron or Gore-Tex) graft (tube). The aorta and its branching arteries are cross-clamped during open surgery. This can lead to inadequate blood supply to the spinal cord, resulting in paraplegia, when repairing thoracic aneurysms. Cerebrospinal fluid drainage, when performed in experienced centers, reduces the risk of ischemic spinal cord injury by increasing the perfusion pressure to the spinal cord.
Tests and diagnosis
To diagnose varicose veins, your doctor will do a physical exam, including looking at your legs while you’re standing to check for swelling. Your doctor may also ask you to describe any pain and aching in your legs.
You may also need an ultrasound test to see if the valves in your veins are functioning normally or if there’s any evidence of a blood clot.
Treatments and drugs
Self-care — such as exercising, losing weight, not wearing tight clothes, elevating your legs, and avoiding long periods of standing or sitting — can ease pain and prevent varicose veins from getting worse.
Treatments and drugs
Self-care Self care such as exercising, losing weight, not wearing tight clothes, elevating your legs, and avoiding long periods of standing or sitting — can ease pain and prevent varicose veins from getting worse.