Aneurysmectomy
Aneurysmectomy is a surgical procedure aimed at removing weakened tissue from arteries or veins where an aneurysm, an abnormal swelling caused by pressure, has developed. Aneurysms can occur in various locations, including the cranial area (cerebral aneurysms), thoracic region, or abdominal area. Symptoms of an acute aneurysm can mimic those of a stroke and may include severe headaches, neck rigidity, and loss of consciousness. Surgical intervention is critical, especially in cases where an aneurysm has ruptured, as this can lead to life-threatening blood loss.
The procedure typically involves clamping the affected area, excising it, and replacing it with a healthy section of artery or vein from the patient. Preoperative assessments, including imaging techniques like CT scans or MRIs, are crucial for early diagnosis, which significantly improves recovery rates. Aneurysmectomies performed before a rupture boast a high recovery rate of 95 to 98%, while post-rupture surgeries have a lower success rate of 50 to 70%. Alongside blood loss, patients may also face risks such as infections, seizures, and other complications during and after the procedure. Thus, timely and effective medical intervention is essential for favorable outcomes in patients with aneurysms.
Aneurysmectomy
Anatomy or system affected: Abdomen, brain, chest, heart
Definition: A surgical procedure to repair an aneurysm, which occurs when an arterial or venous wall balloons
Indications and Procedures
An aneurysm occurs when an artery or vein swells as pressure builds within it. Although aneurysms can occur wherever there are arteries or veins, typical occurrences are cranial (called cerebral aneurysms), thoracic, or abdominal. A major cause of aneurysms is a narrowing or blockage of clogged arteries or veins.
People who experience acute aneurysms are sometimes mistaken for stroke victims. Typical indications are a cessation of eye movement accompanied by a drooping of the eyelids and dilation of the pupil, rigidity in the neck, intense headache, and loss of consciousness.
Many aneurysms are repaired through bypass surgery, where the affected area is clamped shut and excised. The area is then replaced by a section of artery or vein from the patient’s leg, which is sutured into place. Controlling blood loss during such surgery is essential. If an aneurysm has ruptured, then numerous blood transfusions are likely to be required during the surgery, and preoperative blood typing is indicated. Patients are anesthetized when the surgeon is ready to make the first incision. A sterile surgical field is of the utmost importance for this procedure. As they are exposed, blood vessels are sealed immediately with hemostats (forceps) to control bleeding.
Uses and Complications
Aneurysmectomies are used to remove weakened tissue in arteries and veins at the site where ballooning has occurred or is imminent. The immediate danger posed by aneurysms is rupture, which can quickly lead to fatal blood loss. It is, therefore, imperative that medical assistance be rendered immediately. Treatment usually involves surgery to remove the aneurysm. In cases requiring emergency surgery, the prognosis is poor.
Aneurysms are sometimes diagnosed through X-rays and angiograms before they become symptomatic. Cerebral aneurysms are best detected through computed tomography (CT) scans or magnetic resonance imaging (MRI). When an early diagnosis is made, surgery can be performed under more controlled conditions than those that accompany emergency surgery. For aortic aneurysms, surgery before a rupture occurs usually has a recovery rate of 95 to 98 percent, whereas the recovery rate for surgery performed after an aneurysm has ruptured is between 50 and 70 percent with death usually occurring from complications such as kidney failure.
An aneurysm that occurs in the aorta is particularly dangerous because it creates a buildup of pressure around the heart so intense that it can cause the heart to stop beating. Although blood loss presents the greatest immediate risk in aneurysmectomy, seizures, cerebral edema, hydrocephalus, and infection may also present significant risks for patients.
Bibliography
"Aneurysm Repair." Texas Heart Institute, August 2012.
"Aortic Aneurysm Repair—Endovascular." Medline Plus, December 10, 2012.
"Brain Aneurysm Repair." Medline Plus, July 19, 2012.
“Aneurysm Surgery: Procedure Details and Recovery.” Cleveland Clinic, 25 Apr. 2022, my.clevelandclinic.org/health/treatments/16735-aneurysm-surgery-traditional-open-surgery. Accessed 21 July 2023.
"How Is an Aneurysm Treated?" National Heart, Lung, and Blood Institute, April 1, 2011.
Melander, Sheila Drake, ed. Case Studies in Critical Care Nursing: A Guide for Application and Review. 3d ed. Philadelphia: W. B. Saunders, 2004.
Phillips, Nancymarie Fortunato. Berry and Kohn’s Operating Room Technique. 12th ed. St. Louis, Mo.: Mosby/Elsevier, 2012.
Phippen, Mark L., and Maryanne Papanier Wells. Patient Care during Operative and Invasive Procedures. Philadelphia: W. B. Saunders, 2000.