Aneurysm Repair Surgery in India
What is Aneurysm?
An aneurysm is a localised balloon like bulge in a blood vessel. An aneurysm can occur both in a vein and in an artery. Arterial aneurysm is much more common than venous aneurysms. Aneurysm occurs due to the loss of elasticity of the walls of the blood vessels. As the size increases, the blood pressure on the walls of the blood vessels increases leading to its rupture. The internal bleeding thus generated can cause a lot of complications including potentially fatal ones.
The causes of an aneurysm:
Though the exact cause of an aneurysm remains unclear, a pronounced damage to the surface of the blood vessel at a particular part is thought of as the main contributing factor. Heredity, atherosclerosis, high blood pressure, bacterial infections like syphilis, fungal infections, aging etc are also known to be the main causative factors of an aneurysm. Similarly, a personal history or family history of an aneurysm and certain genetic disorders like Marfan syndrome, Loeys-Dietz syndrome, Ehlers-Danlos syndrome are thought of as other predisposing factors.
The most common sites of occurrence of aneurysms are:
Though an aneurysm can occur in any blood vessel, there are certain arteries that are much more prone to develop one than others. Aneurysms can occur in the large arteries or on the peripheral arteries.
The large arteries that are commonly affected are:
Aorta- Aortic aneurysms can develop in the abdominal part of the aorta called Abdominal aortic aneurysm or on the thoracic part of the aorta called Thoracic aortic aneurysm. Abdominal aortic aneurysm is more common and creates more complications as compared to the other.
Cerebral Artery- aneurysms that occur in the arteries supplying in the brain are called as Cerebral aneurysms. These are potentially fatal (about 40 percent) or have the capability to create a resultant neurological impairment or disability (about 70 percent).
The main types of peripheral aneurysms are:
Popliteal aneurysm- behind the knee
Femoral artery aneurysm- in the groin
Carotid artery aneurysm- in the neck
Visceral aneurysm- in the arteries supplying the intestines and kidneys
Splenic artery aneurysm- in the spleen
The common symptoms of an aneurysm:
Most of the aneurysms do not create any signs or symptoms until they rupture. Abdominal aortic aneurysms can produce symptoms like abdominal pain, lower back pain or a pulsating sensation in the abdomen. Thoracic artery aneurysms can create discomfort in breathing, swallowing etc. They may also cause pain in the jaw, chest and the upper back.
The rupture of an aortic aneurysm can create symptoms like:
Severe chest or back pain
The rupture of a cerebral aneurysm can create symptoms like:
Sudden onset headache of extreme severity
Drooping of eyelids
Muscular weakness or paralysis
The treatment for aortic and cerebral artery aneurysms:
Though surgical repair is the most preferred mode of treatment, surgeons look upon a variety of factors before undertaking any procedure. They are:
the size of aneurysm
the location of aneurysm
the shape of aneurysm
the effects of aneurysm
general health of the patient
the potential after effects of surgery
Any aneurysm that is more than 5-6 cm in diameter is liable to be surgically repaired because of the potential after effects like severe internal bleeding in case of a rupture.
Aneurysm Repair Surgery in India- Surgical treatment for aortic aneurysm:
There are two types of surgical procedures for repairing an abdominal aortic aneurysm:
Open repair surgery- in this method the surgery is done under general anaesthesia. The surgeon makes a large incision in the abdomen to expose the aneurysm. The part of the blood vessel above and below the aneurysm is clamped to prevent blood flow. After this, the affected aneurysm portion is cut off and a graft is attached to the ends of the blood vessels. Once this is complete the clamps are taken away to permit proper flow of the blood. The most common complications during surgery is bleeding while post-surgical complications are bleeding, infection, impairment of the function of the adjacent and anatomical structures like the colon, erectile dysfunction etc. Since rupture of an aortic aneurysm is a potentially dangerous complication, potential risks due to the surgery is carefully weighed against this and an appropriate decision is to be taken after getting the patient's consent.
Endo-vascular repair surgery- a minimally invasive and a relatively new technique, endovascular repair do not require large incisions. The surgery is done under general anaesthesia. Arteries in the groin area are inserted with catheters through small incisions superficially. Through these catheters, a stent graft is moved till it reaches the aneurysm. Once this is complete, the stent is expanded by using a balloon like device to attach it to the walls of the blood vessels. The catheter is then slowly removed. The potential complications of this surgery include bleeding, infection, stent graft failure etc. Being a minimally invasive procedure, the risk of heavy bleeding and incision site infection are comparatively lower in comparison with an open repair surgery.
Surgical treatment for cerebral aneurysm:
Though the rupture of a cerebral aneurysm proves fatal or induces permanent disability, surgery to repair the same is also bound to create equally serious complications. So, the surgeons usually resort to surgery only if the potential benefits far outweigh the risks.
The main types of surgical procedures for repairing cerebral artery aneurysm are:
Surgical clipping: In this procedure, a small portion of the skull is opened to help the surgeon access aneurysm site. The blood vessel that supplies the aneurysm is clipped to prevent blood flowing into it. After this, the opening in the skull is closed.
Endovascular coiling: A minimally invasive procedure where detachable coils are deployed in the aneurysm affected area through a catheter inserted into a blood vessel in the groin region. Femoral arteries are the usually selected for the procedure. Once the aneurysm is coiled blood flow through these areas becomes sluggish leading to a clotting of blood inside the aneurysm that acts like a seal that prevents further flow of blood through aneurysm.
Aneurysm repair surgery cost in India:
Aneurysm repair cost in India is approximately around 17,000 USD or 1,116,500 INR. It is much lower as compared to the prices of the procedure in most of the developed countries like US & UK.
Dos and Don'ts after surgery:
Take medicines as prescribed
Don't smoke or drink
Do not lift heavy weights
Eat a low fat, low cholesterol diet
Keep up the follow up appointments
Don't exert beyond limits prescribed by the doctor
Take proper rest
Hold a pillow over the incisions while coughing or taking deep breathe
Don't drive till permitted by the doctor