Diseases of the arteries can lead to dilation of the vascular wall, this is called aneurysm. There are several locations where an arterial aneurysm is more common.
The following aneurysm of the artery is more common:
- Aneurysm of the abdominal aorta (abdominal aortic aneurysm)
- Aneurysm of the pelvic artery (iliac lumbar aneurysm)
- Aneurysm of the knee impact (popliteal aneurysm)
- Aneurysm of descending thoracic aorta (descending aneurysm)
- Aneurysm of ascending thoracic aorta (ascending aneurysm)
- Aneurysm of the arch of the thoracic aorta (aortic arch aneurysm)
- Aneurysm of the thoracic and abdominal aortas (thoracoabdominal aneurysm)
- Seam aneurysm
All aneurysms run the risk that the dilated and weakened arterial wall can no longer withstand the blood pressure at this point. The result is the painful tear (rupture) with blood leakage to the outside.
The rupture risk increases with the maximum diameter of the aneurysm. It should then be an invasive vascular treatment, when the diameter has reached a certain size. Every aneurysm can be seen individually here and no general recommendation can be made as to when an invasive therapy makes sense. In addition to the size of the aneurysm plays an essential role in the appearance of whether growth has taken place so far, and what other diseases are present in the affected patient.
In the Aortensprechstunde you will be fully informed about your aneurysm disease. Then you can ask your questions. Together with you, it will then be determined which procedure makes the most sense in your case.
Concentrated competence: More than 130 top doctors from Munich and the region explain their best therapies to common diseases or frequent complaints for potential patients. Today it's about vascular diseases. These include, for example, narrowing of the carotid artery and aortic aneurysms. There is a great danger behind this technical term. Because if these enlargements of the main aorta burst, the patient is in acute danger to life. Medical doctors speak of "silent killers" - because the patient usually has no complaints at first. It is therefore advisable to have an appropriate preventive medical check-up. If the aneurysm is discovered at an early stage, specialists can remove it using modern surgical technology. Further topics of this episode: strokes and venous diseases.
Aneurysm is a pathological, sometimes life-threatening dilation or sagging of a blood vessel.
Type or name of the therapy: Surgical therapy of the abdominal aortic aneurysm (abdominal aortic aneurysm).
These examinations are necessary: Clinical examination, ultrasound (B-scan or duplex sonography), CT angiography (computed tomography with contrast medium), clarification of other organs (especially heart, lungs, kidneys) before an operation.
Two surgical procedures:
- Endovascular therapy with stent prostheses, which are anchored via the inguinal vessels from the inside (“endovascular”) above and below the aneurysm. This takes the pressure off the enlarged wall of the diseased main artery.
- Open replacement of the enlarged aorta by inserting an artificial main artery as a simple tubular prosthesis or so-called Y prosthesis. For this purpose, the abdominal aorta must be surgically exposed and temporarily clamped above and below the aneurysm (large skin incision, greater stress on the heart, lungs, kidneys).
The procedure: Both surgical procedures are performed under general anesthesia, in individual cases the endovascular therapy can also be performed under local anesthesia (groin). The endovascular therapy lasts 60 to 90 minutes, the open surgery between 90 minutes and 3 hours. Inpatient treatment averages 5 to 7 days (endovascular) and 10 to 14 days (open surgery).
Type or name of the therapy: Surgical replacement of the ascending main artery (ascending aorta), possibly up to the so-called aortic arch.
These examinations are necessary: interrogation, physical examination to assess the rest of the vascular system and the heart valves, X-ray, cardiac ultrasound, CT with contrast medium, left heart catheter examination with coronary angiography (cardiac catheter).
The typical complaints: Usually no complaints at first. Only when such aorta outbreaks become very large can they lead to symptoms such as shortness of breath, difficulty swallowing or hoarseness in the chest.
Here's how it works: The enlarged section of the aorta is replaced by a so-called tubular prosthesis - this is a stent made of high-tech plastic threads. The connections between the prosthesis and the own main artery are sewn with a nylon-like thread. You need the so-called heart-lung machine to maintain the blood circulation while working on the opened aorta. The heart is shut down with a so-called cardioplegic solution for the duration of the operation.
The procedure: The operation takes place under general anesthesia using the heart-lung machine, access by longitudinal splitting of the breastbone, which is stabilized again with wires at the end of the procedure. The duration of the operation is about three to four hours. The patient is then monitored in the intensive care unit for a day or two. Most patients stay in the hospital for about two weeks and then do three-week rehab.
3D printer vessels help with aortic aneurysms
Thanks to a vascular model from the 3D printer, the vascular doctors at Leipzig University Hospital were able to help seven people and thus save their lives.
Because an individually created plastic model helps doctors to create and implant a precisely fitting prosthesis in the event of a life-threatening sacking of the aorta, the main artery. The unique procedure used was developed by a research group at the Leipzig University Hospital and has now been successfully used in practice. The project has now been awarded the local IQ Innovation Award by the city of Leipzig.
If a patient develops an aortic aneurysm, i.e. a sagging of the main artery, only timely surgery helps. Because there is a risk of tearing due to the widening of the vessel walls - a situation that is extremely life threatening. The larger the aneurysm, the faster surgery is required. "We then insert a prosthesis in the expanded area that stabilizes the vessel," explains Dr. Daniela Branzan, vascular surgeon at Leipzig University Hospital. "In order for this prosthesis to fit as well as possible, we have to adapt it individually in advance in the case of complicated cases," continues Branzan. So far, this adjustment has either been laborious and with limited accuracy by hand using the 2D images, or in the longer term and more precisely by an external company that manufactured individual prostheses. For the patients, this meant uncertainty or a waiting period of two to three months. "But we don't have this time in emergencies," said Branzan. That is why the vascular doctor was thrilled when she came across a project in-house: a research group was working on applications of 3D print models in neurosurgery.
The basis for this was the "next3D" technology platform developed by UKL doctors and scientists together with the Fraunhofer IWU. This platform contains a software-supported process chain that evaluates medical images and transfers them to three-dimensional print templates. The first product developed here at the UKL was a customized system for neurosurgical interventions, a so-called stero-taxi frame. With the help of this device, electrodes are placed in the brain with high precision. For the researchers, the other possible uses of the method were obvious: "We were certain that our method would also enable us to quickly and precisely produce aortic vascular models based on computed tomography data," says Dr. Ronny Grunert, head of the research group. The result proves him right: with the new procedure, the Leipzig vascular physicians can now produce an individual plastic vascular model with the 3D printer within 24 hours. The prosthesis can be fitted onto this model like a template and precisely adapted to the branches of the vessels. This increases the chances of a successful operation of the life-threatening aneurysm, because the treatment time is significantly reduced. The prostheses immediately fit perfectly and stabilize the endangered area without hindering other vessels. The new method has been used seven times in the last ten months for high-risk patients for whom there was no other treatment option. All patients are fine today. "It is very likely that these patients owe their lives to the new procedure," says Dr. Branzan.
The research group has already reported on these pleasing results from the use of 3D printing in vascular medicine in the renowned journal "JACC" and at several congresses. "We therefore know that there is currently only one other team in Seattle besides us that uses a partially similar procedure," says vascular surgeon Branzan. The Leipzig method is unique, a patent has already been registered. In June the project was also awarded the Leipzig City Prize at the 15th IQ Central Germany Innovation Award.