An aneurysm is a dangerous bulging or ballooning in the wall of a blood vessel, often an artery, caused by weakness in the vessel wall. Treating an aneurysm depends on its size, location, symptoms, and risk of rupture. The main goals of treatment are to prevent rupture, relieve symptoms, and restore normal blood flow.
There are several approaches to treating aneurysms, broadly divided into **medical management**, **minimally invasive endovascular procedures**, and **open surgical repair**.
**Medical management** is often the first step for small or asymptomatic aneurysms. This involves controlling risk factors to slow aneurysm growth and reduce rupture risk. Patients are typically prescribed medications to lower blood pressure, reduce cholesterol, and prevent blood clots. Lifestyle changes such as quitting smoking, eating a healthy diet, and exercising are also crucial. Regular imaging tests like ultrasounds, CT scans, or MRIs monitor the aneurysm’s size and shape over time to decide if further intervention is needed.
When an aneurysm grows large or causes symptoms, or if there is a high risk of rupture, more active treatment is necessary.
**Open surgical repair** is the traditional and well-established method. It involves making a large incision to directly access the aneurysm. The damaged section of the blood vessel is removed and replaced with a synthetic graft, usually made from durable materials like Dacron. This graft acts as a new, strong vessel wall. Open surgery is highly effective and provides a permanent solution, especially for younger patients with good overall health. However, it is a major operation requiring general anesthesia and a longer recovery period. It is often preferred when the aneurysm’s anatomy is complex or when endovascular options are unsuitable.
**Endovascular aneurysm repair (EVAR or TEVAR)** is a modern, minimally invasive alternative. Instead of a large incision, a small cut is made, usually in the groin, to insert a catheter into the blood vessels. Through this catheter, a fabric-covered metal stent called a stent-graft is guided to the aneurysm site. Once in place, the stent-graft expands and reinforces the weakened vessel wall from inside, creating a new channel for blood flow and preventing pressure on the aneurysm sac. This method causes less pain, has a shorter hospital stay, and faster recovery compared to open surgery. However, not all aneurysms are suitable for EVAR due to anatomical considerations, such as the shape and location of the aneurysm and the condition of the blood vessels leading to it.
For **brain aneurysms**, treatment options include **surgical clipping** and **endovascular coiling**. Surgical clipping requires opening the skull to place a metal clip at the base of the aneurysm, permanently blocking blood flow into it. Endovascular coiling is less invasive, involving threading a catheter to the aneurysm and filling it with tiny platinum coils that induce clotting, sealing off the aneurysm from circulation. The choice depends on aneurysm size, location, and patient health.
Deciding on the best treatment involves careful evaluation by a multidisciplinary team of specialists, including vascular surgeons, interventional radiologists, cardiologists, and neurologists. Factors such as the patient’s age, overall health, aneurysm size, location, symptoms, and risk of rupture guide the choice between observation, medication, endovascular repair, or open surgery.
In some cases, if the aneurysm is small and not causing symptoms, doctors may recommend regular monitoring with imaging and medical management to control risk factors. When intervention is needed, minimally invasive endovascular techniques are often preferred for their lower immediate risks and quicker recovery, but open surgery remains the gold standard fo
