Emergency surgery after aneurysm rupture

All cases of a non-rupturing aneurysm require active treatment, but when the aneurysm ruptures, emergency surgery is required.

Regarding the aortic aneurysm, whether abdominal or thoracic, it requires emergency surgery when there is a rupture. Without immediate intervention, a ruptured aneurysm is always fatal in the thoracic aorta and almost always fatal in the abdominal aorta.

The decision to operate on an unruptured aneurysm in the aorta depends on a number of factors related to the patient’s condition, age, and characteristics of the aneurysm itself (size and speed of development).

To operate on an aortic aneurysm, there are two operating techniques that will be chosen depending on the severity and location of the aneurysm.

The conventional surgical method.

It requires removing the aneurysm after clamping (using forceps) of the artery. Circulation in the aorta is interrupted and the damaged part of the artery will be replaced with a prosthesis.

Endovascular surgery

It is a minimally invasive procedure that involves inserting a plastic tube (catheter) into an artery, usually in the groin, and then pushing a platinum wire through the catheter to the site of the aneurysm. The thread winds inside the aneurysm, disrupting blood flow and causing blood to clot. Endovascular surgery is generally preferred over traditional surgery, especially because the operating time and hospital stay are shorter.

Endovascular surgery, however, carries risks, in addition to those usually encountered during surgery.

Aneurysms that are less likely to rupture are not treated surgically because of the potential risk of brain damage resulting from possible surgical complications.

Patients are then counseled on how to monitor and modify, if possible, factors that increase the risk of a ruptured brain aneurysm. This concerns in particular the control of blood pressure. Indeed, if the person is treated for high blood pressure, its treatment with an antihypertensive agent would reduce the risk of rupture.

When a ruptured brain aneurysm causes subarachnoid hemorrhage, the patient will be rushed to hospital and undergo brain surgery to close the ruptured artery, in an effort to prevent further bleeding.

Non-surgical treatment of brain aneurysms with rupture

There are drug treatments available to relieve symptoms and manage complications.

• Pain relievers, such as acetaminophen can be used to treat headaches.
• Calcium channel blockers prevent calcium from entering cells in the walls of blood vessels. These medicines can decrease the narrowing of the blood vessels (vasospasm) which can be a complication of an aneurysm. One of these drugs, nimodipine, appears to reduce the risk of brain damage caused by insufficient blood flow following subarachnoid hemorrhage.
• Anti-seizure drugs can be used to treat seizures associated with an aneurysm. These drugs include levetiracetam, phenytoin, and valproic acid.
• Rehabilitation therapy. Damage to the brain caused by subarachnoid hemorrhage can lead to the need for rehabilitation of physical skills, speech, and occupational therapy.

Sites of interest and sources

Sites of interest:

Cerebral aneurysm: definition, symptoms, treatment (Sciences et Avenir)

Cerebral aneurysm (CHUV, Lausanne)

sources: 

Dr Helen Webberley. Aneurysm: Causes, Symptoms and Treatments. Medical News Today, mars 2016.

Brain aneurysm. Mayo clinic, September 2015.

What is aneurysm ? National Heart, Lung, and Bool Insitute , avril 2011.