Treatment of Aneurysm

As with the symptoms and diagnosis, the treatment of aneurysms will depend on their site.

Aortic and Peripheral Aneurysms

The first step to treating an aneurism is usually to reduce the patient's blood pressure to lower the risk of the aneurysm developing further and rupturing. Depending on the aneurysm's size, location and its likelihood of rupture, surgical treatment may also be carried out. However, before any such treatment is decided upon, the risk of surgery must be weighed up against the risk of non-surgical intervention. Rapidly expanding aneurysms are often operated on as soon as possible, as they have a high risk of rupture, whilst aortic aneurysms that expand slowly at less than 1 cm a year are usually monitored by routine diagnostic testing. Current guidelines suggest elective surgical repair when the diameter of the aneurysm is greater than about 5-6 cm.

For aortic aneurysms or aneurysms that develop in the vessels that supply blood to the head, legs and arms (the peripheral vessels), the main surgical procedure involves replacing the weakened section of the vessel with a piece of synthetic fabric tubing (Gore-tex or Dacron), called a graft. This provides the aneurysm with the support necessary to prevent it from enlarging further. A branched graft may be necessary for an aneurysm that affects the area of the aorta that branches to the legs.

Another form of treatment involves inserting a metallic stent by placing a catheter into the through the artery at the groin (termed endovascular treatment). The stent is then deployed across the aneurysm.

Cerebral Aneurysms

If the patient is admitted to hospital with a ruptured cerebral aneurysm, their initial treatment requires immediate stabilisation to prevent further bleeding. Surgery is then usually performed within three days to block the ruptured aneurysm to and reduce the risk of re-bleeding.

This was traditionally carried out by placing a small metallic clip across the base of the aneurysm to protect the weak aneurysm wall from blood flow. The artery wall was reconstructed at the same time to maintain blood flow to the brain. However, surgery is now increasing being carried out using a less invasive technique, known as endovascular treatment. This involves inserting a thin catheter into the groin area and threading it through the blood vessels to the site of the aneurysm. Once in place, tiny platinum coils are placed inside the aneurysm, blocking blood flow and preventing re-bleeding. Other techniques include injected sialastic balloons or biological glue materials.

In general, young patients who are admitted to hospital with Hunt and Hess grade 1 or 2 haemorrhage can anticipate a good outcome, whilst older patients and those with poorer Hunt and Hess grades tend to have a less rosy prognosis. Unfortunately, around two thirds of patients who are admitted with a ruptured cerebral aneurysm have a poor outcome - death or permanent disability.