What are the treatment guidelines for aneurysms?

From the Guidelines

Treatment of aneurysms should be individualized based on their location, size, and risk of rupture, with consideration of patient age, medical comorbidities, and aneurysm morphology, as recommended by the most recent guidelines from the American Heart Association/American Stroke Association 1. The management of aneurysms involves a multidisciplinary approach, including medical management, surgical intervention, and lifestyle modifications.

• Medical management includes blood pressure control with medications like beta-blockers, ACE inhibitors, or calcium channel blockers to maintain blood pressure below 140/90 mmHg.
• Surgical treatment options include endovascular repair (EVAR) or open surgical repair with replacement of the affected vessel segment with a synthetic graft.
• Brain aneurysms may require specialized treatments like coil embolization or surgical clipping.
• Post-treatment, patients need lifelong monitoring with periodic imaging studies to prevent rupture, which can be life-threatening, particularly for brain aneurysms that can cause subarachnoid hemorrhage or for aortic aneurysms that can lead to massive internal bleeding. The choice of treatment modality should be based on the individual patient's characteristics, including age, aneurysm location, and medical comorbidities, as well as the expertise of the treating physician and the availability of resources, as suggested by the guidelines 1. In general, endovascular coil occlusion of the aneurysm is a recommended treatment option for patients with a ruptured cerebral artery aneurysm that is deemed treatable either by endovascular coiling or by surgical clipping 1. However, the decision to use endovascular or open surgical repair should be made on a case-by-case basis, taking into account the patient's individual characteristics and the potential risks and benefits of each treatment option, as recommended by the guidelines 1. It is also important to note that the quality of the evidence supporting recommendations for treatment modality is relatively limited, and further studies are necessary to determine the best approach for each individual patient 1.

From the Research

Aneurysm Treatment Guidelines

• The treatment guidelines for aneurysms vary depending on the type and size of the aneurysm, as well as the patient's overall health and medical history.
• For abdominal aortic aneurysms (AAAs), statin therapy may be associated with a reduction in AAA progression, rupture, and lower rates of perioperative mortality following elective AAA repair 2.
• The Society for Vascular Surgery practice guidelines recommend endovascular repair as the preferred method of treatment for ruptured aneurysms, and suggest that elective EVAR be limited to hospitals with a documented mortality and conversion rate to open surgical repair of 2% or less 3.
• Antiplatelet therapy may be beneficial in reducing the risk of thromboembolic events in patients with intracranial aneurysms, particularly those with high-risk features 4, 5.
• Ultrasonographic screening for AAAs can be an effective way to detect and monitor aneurysms, and may be recommended for men 65 to 79 years of age who have ever smoked 6.

Treatment Options

• Endovascular repair: a minimally invasive procedure where a stent graft is placed inside the aorta to reinforce the weakened area.
• Open surgical repair: a traditional surgical procedure where the aneurysm is repaired through an incision in the abdomen.
• Elective repair: a planned surgical procedure to repair an aneurysm before it ruptures.
• Surveillance: regular monitoring of the aneurysm with imaging tests, such as ultrasonography, to track its size and growth.

Patient Management

• Patients with AAAs should be managed by a multidisciplinary team, including vascular surgeons, cardiologists, and primary care physicians.
• Patients should be educated about the risks and benefits of treatment options, and involved in the decision-making process.
• Patients with high-risk features, such as smoking or cardiovascular disease, should be closely monitored and considered for aggressive treatment.
• Patients with ruptured aneurysms should be treated promptly and aggressively to minimize morbidity and mortality.