Surgery for aortic aneurysms may be done on an emergency basis, or if detected in advance, it may be planned as an elective procedure. Emergencies occur when an aneurysm ruptures or the aorta dissects, requiring immediate surgery. This page discusses the evaluation process by which the need for non-emergency surgery is determined. The decision to monitor a patient instead of operating is made on an individual basis but is guided by factors listed below.
Aortic Root Surgery
For patients who have aneurysms of the aortic root (the place where the ascending aorta meets the heart muscle), there are two main indications for surgery. 1) If there is an aneurysm in the aortic root and the aortic valve is calcified or stenotic, replacement of the aortic root may be necessary. When operating because of bicuspid valve disease, an aortic root procedure is usually considered essential if the root diameter is enlarged to 4 cm or greater. 2) If the valve is functioning well, surgical intervention is not considered until the diameter of the aorta exceeds 5cm.
Aortic Arch Surgery
Surgery is usually performed if the diameter of the aorta reaches 5.5 cm (or more or less, depending on the person's height). More precise determination is based on the ratio between the average diameter compared to the abnormal vessel size.
Surgery for a Descending Aortic Aneurysm
Aneurysms in the descending aorta generally result from atherosclerosis ("hardening of the arteries") in older patients. The evaluation usually begins with a CT scan or MRI, during which the surgeon carefully checks to see which type of repair may be best. Some patients benefit most from repair using a stent, others need traditional open surgery, and still, others benefit from hybrid procedures that blend the open repair with the use of stent grafts.
If an aneurysm is tiny, it may not require surgery initially. Most patients who are evaluated for aneurysms do not need surgery. Diagnosis of an aneurysm is a frightening thing to many patients, but in the majority of cases, it is a dilated aorta that can be monitored with CT scans, and will not worsen to the point that requires surgery.