Aneurysm

An aneurysm is a pressurized bulge in a blood vessel. Aneurysms can be life-threatening if they rupture. 

Vascular surgeons at the Washington University and Barnes-Jewish Heart & Vascular Center helped develop many aneurysm therapies, including endovascular aneurysm repair. Here, you receive care from specialists who have used minimally invasive aneurysm treatments since they first became possible in the early 1990s.

Why Choose Barnes-Jewish Hospital for Aneurysm Care?

Our team includes world-recognized experts in treating aneurysms. Patients and physicians choose us for: 

• New therapies: For decades, we have worked to understand the causes of aneurysm disease and advance new treatments. We helped develop some of the most sophisticated and least invasive aneurysm surgery techniques, such as endovascular aneurysm repair. Learn more about our innovation.
• Advanced care for aortic arch and thoracoabdominal aneurysms: Through clinical trials, we have access to new devices to provide endovascular treatment for aneurysms in the aortic arch (top of the aorta) and chest. We are the only program in the Midwest with access to some of these devices, which provide additional options for patients who are not candidates for open surgery.
• Expertise: Physicians across the United States refer patients to us for complex aneurysms in the upper abdomen or chest. We routinely treat rare aneurysms involving blood vessels to the kidneys, intestines, liver or spinal cord.
• Excellent outcomes: Annually, we treat more than 250 patients with aortic aneurysm disease. We see many patients who need the most complex care. Research shows that patients have better results in programs that treat a high volume of patients.
• Personal attention: Vascular surgeons at the Heart & Vascular Center carefully review each case. We take time to listen to you and help you understand the risks and benefits of treatment.
• Second opinions: Even if you have been evaluated elsewhere, you are welcome to see our vascular surgeons for a second opinion. We discuss your treatment options so you can make an educated decision about your care.

What Is an Aneurysm?

An aneurysm is a blood vessel problem that most often occurs in older adults. When part of a blood vessel weakens, it may bulge out (like a balloon) and get thinner. This weak area of the blood vessel appears on diagnostic imaging as a bulge. 

Blood pumps through these blood vessels under pressure. As the blood vessel wall weakens, the aneurysm grows. If the wall becomes weak enough, the blood vessel can tear or rupture, causing you to lose a lot of blood quickly. A ruptured aneurysm is life-threatening and needs emergency care.

Aortic aneurysm is the most common and dangerous type of aneurysm. It affects the aorta, the body’s largest artery. The aorta travels up from the heart (ascending aorta). Then the aorta curves back down through the chest and into the abdomen (belly). 

Types of Aneurysms We Treat

Aneurysms can occur in any blood vessel, but they most commonly affect the aorta. We treat all types of aneurysms, including:

• abdominal aortic aneurysm (AAA), the most common type, is a bulge in the part of the aorta that passes through the belly
• thoracic aortic aneurysm (TAA), which develops in the ascending aorta in the chest and is sometimes related to a genetic disorder
• thoracoabdominal aneurysm, which occurs in the part of the aorta that extends from the chest into the belly, affecting both areas
• mesenteric and renal aneurysms, a type of mesenteric (intestinal) and renal (kidney) vascular disease that causes a weak spot or bulge in the arteries that carry blood to the intestines or the kidney
• femoral and popliteal aneurysms, aneurysms that occur in the thigh (femoral artery), knee or calf (popliteal artery)

Aortic Dissection Treatment

An aortic dissection is a tear in the inner layer of the aortic wall. When this vessel tears, blood flows between the layers of the wall of the aorta. It can cause: 

• blood loss that affects critical organs
• aneurysm
• aortic rupture

An aortic dissection often creates severe back pain that may include a stabbing, tearing or ripping sensation. An aortic dissection in the ascending aorta (the section of the aorta leaving the heart) requires emergency open-heart surgery. We work with cardiac surgeons to perform this repair. 

For an aortic dissection in the descending aorta, we may recommend monitoring the dissection. We may prescribe medication to control your blood pressure. If the dissection does not heal on its own, surgery may be the best option. 

Risk Factors for Aneurysm

Some aneurysms are unpredictable, while others are related to underlying conditions. 

Aortic aneurysms may be related to: 

• bicuspid aortic valves (an aortic valve with only two flaps instead of three)
• hypertension (high blood pressure)
• atherosclerosis (buildup of plaque in the arteries)
• inflammatory conditions
• trauma
• underlying genetic disorder, such as:
  • familial thoracic aortic aneurysm and dissection syndrome
  • Loeys-Dietz aneurysm syndrome
  • Marfan syndrome
  • Turner syndrome
  • vascular Ehlers-Danlos syndromes 

Symptoms and Complications of Aneurysm

Most of the time, an aneurysm does not cause pain or discomfort. Chest or back pain could be a sign that the artery wall is too weak to support the pressure of the blood inside. 

Tender and painful aneurysms may pose a particular risk of rupture. The Heart & Vascular Center offers immediate evaluation and treatment for aneurysms, 24 hours a day, seven days a week.

If you know you have an aneurysm and you experience pain, you should seek care right away from a specialist.

Diagnosing an Aneurysm

A routine exam cannot detect an aneurysm. For a complete evaluation of an aneurysm, your doctor may order: 

• ultrasound, a noninvasive test using sound waves to show images of your aorta
• chest X-ray, which provides pictures of your heart and chest and may reveal an aneurysm
• transthoracic echocardiography (echo), or TTE, which uses sound waves to produce images of your heart and aorta
• transesophageal echo (TEE), which provides clear images of your heart and aorta via a wand inserted in your esophagus (the tube from your throat to your stomach)
• MRI and CT scans to create 2D and 3D pictures of your aorta and blood vessels

Aneurysm Treatment and Surgery

Not all aneurysms need surgery right away. For a small aneurysm, you may have regular scans to monitor the aneurysm’s growth.

If you need aneurysm treatment, your surgeon will most likely use an endovascular approach. We also perform open surgery if the minimally invasive approach is not right for you. When an aneurysm affects long portions of the aorta, we work closely with the cardiothoracic surgeons of the Heart & Vascular Center in a multidisciplinary team approach. Read more about cardiac surgery.

Endovascular aneurysm repair (EVAR)

Surgeons can repair an aneurysm from inside a blood vessel, using X-ray images as guides. Our surgeons pioneered this technique and have performed more than 5,000 EVAR procedures. Through clinical trials, we have access to devices that can treat aneurysms in complex areas, including thoracoabdominal aneurysms (affecting both the chest and abdomen).

During EVAR, the vascular surgeon: 

1. makes a small puncture in your groin
2. threads a catheter (narrow tube) into the femoral artery, a large vessel in your leg
3. assembles a fabric-lined endograft (tube) inside the aorta, in the aneurysm, relining the aneurysm to relieve pressure and prevent the aneurysm from bursting

After EVAR, many patients only need to stay overnight in the hospital. You go home within one to three days. You can get back to your usual activities within two to three weeks.

Fenestrated endovascular aneurysm repair (FEVAR)

The Heart & Vascular Center has been a leader in the development of FEVAR. This therapy treats abdominal aortic aneurysms that are close to the arteries that feed the kidneys. 

For these aneurysms, a traditional stent would block blood flow to the kidneys. Instead, we use custom-made fenestrated stents. Fenestrations are small openings in the stent graft. We strategically position these openings to let blood continue to flow to your kidneys while preventing the aneurysm from growing or rupturing. 

Thoracic endovascular aneurysm repair (TEVAR)

TEVAR treats problems of the ascending aorta (thoracic aortic aneurysms and thoracic aortic dissection). To access a weakened part of the ascending aorta, your vascular surgeon may insert a catheter through arteries in the wrist instead of in your groin. 

A TEVAR stent graft covers an aneurysm or a tear in the wall of the aorta. By supporting the aorta and diverting blood flow, the repair closes or prevents a rupture and allows the aorta to heal. 

Open surgery for aneurysm repair

Some people are not candidates for endovascular aneurysm repair because of individual anatomy or conditions such as collagen (connective tissue) disorders. For these patients, we turn to traditional open aneurysm repair. 

Surgeons have performed open aneurysm repair for decades. Because we treat a large number of patients, our vascular surgeons are highly experienced and comfortable with open repair. 

To repair an aneurysm this way, your surgeon: 

1. makes an incision in your abdomen or flank (side)
2. briefly stops blood flow in the aneurysm
3. opens the aneurysm and stitches a fabric tube to the aorta above and below the aneurysm to reinforce the area

After open surgery for an aortic aneurysm, you typically stay five to seven days in the hospital. You continue to heal at home for four to six weeks.

Contact Us

To make an appointment with a Washington University vascular specialist at Barnes-Jewish Hospital, call 314-273-7373.