Can you treat an aneurysm without surgery?
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Ali Azizzadeh, MD, is director of vascular surgery in the Smidt Heart Institute. Photo by Cedars-Sinai. Show
Roxanne Hanks, an independent insurance broker from Simi Valley, is living proof that aneurysms are not always a deadly condition. Hanks' own subtle yet persistent symptoms were in fact signs of an aortic aneurysm. "I was healthy, I exercised and still worked full-time," said Hanks, 61. "But I often felt lightheaded and short of breath from minor exertion, like walking a flight of stairs. I was insistent that my doctors keep searching for the answer." Her insistence paid off. After months of medical tests and doctor visits, she received the diagnosis — an aortic aneurysm — and headed straight to the Cedars-Sinai Smidt Heart Institute. Aneurysms are the weakening, or bulging, of blood vessels that can rupture and become life-threatening. And although they can happen anywhere in the body, aneurysms most commonly occur in the brain, or in the main vessels that lead to the heart, legs and arms. This was the case for Hanks, whose aneurysm was wrapped around most of her heart. For decades, many have considered aneurysms a death sentence, but thanks to innovative, minimally invasive procedures, many can be treated before they become critical. "If detected early, there are new interventions like a minimally invasive catheter-based procedure to treat the condition," said Ali Azizzadeh, MD, director of Vascular Surgery at the Smidt Heart Institute. "Historically, we had to fix a blood vessel by hand, which meant open surgery and the higher risk that comes with that. But today, we can fix the problem from the inside, without always having to open up the patient." Risk factors for aneurysms include heredity, smoking, high blood pressure and elevated cholesterol. And while some aneurysms can cause pain, most present no symptoms — which is why they have long been coined a "silent killer."
“  Dr. Azizzadeh’s pioneering work continues the Smidt Heart Institute’s tradition of developing new, faster, smaller and safer alternatives to the treatment of deadly illnesses, Eduardo Marbán, MD, PhD, director, Smidt Heart Institute „ Hanks, though diagnosed early, had a highly complex case. Before she could undergo a minimally invasive procedure, she first had to have open heart surgery performed by Fardad Esmailian, MD, surgical director of Heart Transplant at the Smidt Heart Institute, to repair the front part of her aorta. Two months after open-heart surgery, Hanks was back at Cedars-Sinai for her final, minimally invasive surgery under the expert care of Azizzadeh. Instead of opening Hank's chest, Azizzadeh instead used a catheter-based technique. “Dr. Azizzadeh’s pioneering work continues the Smidt Heart Institute’s tradition of developing new, faster, smaller and safer alternatives to the treatment of deadly illnesses,” said Eduardo Marbán, MD, PhD, director of the Smidt Heart Institute. "Because of these two physicians, I became a grandmother for the first time," said Hanks. "I'm also back to work, back to exercising and living a fulfilling, great life." The key, Azizzadeh stresses, is early detection. He suggests that if you have unexplained pain, coupled with any risk factor, it's important you talk to your doctor and mention aneurysms. "Listen to your body," Hanks said. "I knew something was wrong, but I kept searching and ultimately ended up with the best doctors and care team who saved my life." Brain aneurysms can be treated using surgery if they have burst (ruptured) or there's a risk that they will burst. Preventative surgery is usually only recommended if there's a high risk of a rupture. This is because surgery has its own risk of potentially serious complications, such as brain damage or stroke. Assessing your riskIf you're diagnosed with an unruptured brain aneurysm, a risk assessment will be carried out to assess whether surgery is necessary. The assessment process is usually based on the following factors:
After these factors have been taken into consideration, your surgical team should be able to tell you whether the benefits of surgery outweigh the potential risks in your case. Active observationIf the risk of rupture is considered low, a policy of active observation is normally recommended. This means you won't receive immediate surgery, but you'll be given regular check-ups so your aneurysm can be carefully monitored. You may also be given medication to lower your blood pressure. Your doctor will discuss lifestyle changes that can help lower the risk of a rupture, such as losing weight and eating less saturated fat. Surgery and proceduresIf preventative treatment is recommended, the main techniques used are called neurosurgical clipping and endovascular coiling. Both techniques help prevent ruptures by stopping blood flowing into the aneurysm. Neurosurgical clippingNeurosurgical clipping is carried out under general anaesthetic, so you'll be asleep throughout the operation. A cut is made in your scalp, or sometimes just above your eyebrow, and a small flap of bone is removed so the surgeon can access your brain. When the aneurysm is located, the neurosurgeon will seal it shut using a tiny metal clip that stays permanently clamped on the aneurysm. After the bone flap has been replaced, the scalp is stitched together. Over time, the blood vessel lining will heal along the line where the clip is placed, permanently sealing the aneurysm and preventing it growing or rupturing in the future. Clipping the artery that the aneurysm is formed on, as opposed to clipping the aneurysm itself, is rarely necessary. This is usually only carried out if the aneurysm is particularly large or complex. When this is necessary, it's often combined with a procedure called a bypass. This is where the blood flow is diverted around the clamped area using a blood vessel removed from another place in the body, usually the leg. Endovascular coilingEndovascular coiling is also usually carried out under general anaesthetic. The procedure involves inserting a thin tube called a catheter into an artery in your leg or groin. The tube is guided through the network of blood vessels, up into your head and finally into the aneurysm. Tiny platinum coils are then passed through the tube into the aneurysm. Once the aneurysm is full of coils, blood cannot enter it. This means the aneurysm is sealed off from the main artery, which prevents it growing or rupturing. Coiling versus clippingWhether clipping or coiling is used often depends on the size, location and shape of the aneurysm. Talk to your healthcare team about your treatment options. If it's possible to have either procedure, you should discuss the risks and benefits of both procedures. Coiling has generally been shown to have a lower risk of complications, such as seizures, than clipping in the short term. The long-term risks of further bleeding are low with both of these techniques. Emergency treatmentIf you require emergency treatment because of a ruptured brain aneurysm, you'll initially be given a medication called nimodipine to reduce the risk of the blood supply to the brain becoming severely disrupted (cerebral ischaemia). Either coiling or clipping can then be used to repair the ruptured brain aneurysm. The technique used will usually be determined by the expertise and experience of the surgeons available. Can an aneurysm be fixed without surgery?Treatment with a catheter is done without open surgery. The patient is given an anesthetic. The catheter is inserted into an artery in the groin and then moved up into the blood vessel in the brain that has the aneurysm. The doctor can then place small platinum coils in the aneurysm through the catheter.
Can aneurysms be treated with medication?If you require emergency treatment because of a ruptured brain aneurysm, you'll initially be given a medication called nimodipine to reduce the risk of the blood supply to the brain becoming severely disrupted (cerebral ischaemia). Either coiling or clipping can then be used to repair the ruptured brain aneurysm.
Can you survive an aneurysm without treatment?A ruptured brain aneurysm requires emergency medical treatment. As more time passes with a ruptured aneurysm, the likelihood of death or disability increases. About 75% of people with a ruptured brain aneurysm survive longer than 24 hours.
Can you treat an aneurysm before it bursts?Endovascular coiling
A surgical clip, an endovascular coil or a flow diverter can be used to seal off an unruptured brain aneurysm and help prevent a future rupture. However, in some unruptured aneurysms, the known risks of the procedures may outweigh the potential benefit.
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