From the Guidelines
Elective repair for patients presenting with a saccular aneurysm ≥45 mm may be considered. Aortic saccular aneurysms are a type of aneurysm that affects only a portion of the aortic wall, and their management depends on size, location, and growth rate. According to the 2024 ESC guidelines for the management of peripheral arterial and aortic diseases 1, the size threshold for considering elective repair for saccular aneurysms is ≥45 mm.
Key Considerations
- The guidelines recommend elective repair for abdominal aortic aneurysms (AAA) if the diameter is ≥55 mm in men or ≥50 mm in women 1.
- For patients with unruptured AAA and aneurysm growth ≥5 mm in 6 months or ≥10 mm per year, repair may be considered 1.
- Endovascular repair is recommended over open repair for ruptured AAA with suitable anatomy to reduce peri-operative morbidity and mortality 1.
Management Approach
- Blood pressure control is essential, typically aiming for less than 130/80 mmHg using beta-blockers or ACE inhibitors.
- Statins may help stabilize the aneurysm.
- Smoking cessation is crucial as it accelerates aneurysm growth.
- Regular imaging surveillance is necessary, typically every 6-12 months for aneurysms approaching intervention thresholds.
- Patients should be educated about symptoms of rupture, including severe, sudden pain, and instructed to seek emergency care immediately if these occur.
Additional Recommendations
- Prior to AAA repair, DUS assessment of the femoro-popliteal segment, to detect concomitant aneurysms, should be considered 1.
- In patients with AAA with suitable anatomy and reasonable life expectancy (>2 years), EVAR should be considered as the preferred therapy, based on shared decision-making 1.
From the Research
Definition and Characteristics of Aortic Saccular Aneurysm
- Aortic saccular aneurysms are a type of aneurysm that can occur in the aorta, which is the main artery that carries blood from the heart to the rest of the body 2.
- They are characterized by a localized dilation of the aortic wall, which can be spherical or sac-like in shape.
- Saccular aneurysms can occur in any part of the aorta, including the ascending aorta, aortic arch, descending thoracic aorta, and abdominal aorta.
Diagnosis and Treatment
- Diagnosis of aortic saccular aneurysms is typically made using computed tomography (CT) scans or other imaging modalities 2.
- Treatment options for aortic saccular aneurysms include surgical repair, endovascular aneurysm repair (EVAR), and open surgery 2, 3.
- The choice of treatment depends on the size and location of the aneurysm, as well as the patient's overall health and medical history.
Complications and Outcomes
- Aortic saccular aneurysms can rupture, which can be life-threatening 2, 4.
- Complications of surgical repair can include infection, bleeding, and damage to surrounding tissues 3.
- Outcomes after treatment of aortic saccular aneurysms are generally good, but can vary depending on the individual patient and the specifics of their treatment 2, 4.
Management and Follow-up
- Patients with aortic saccular aneurysms require regular follow-up with imaging studies to monitor the size and growth of the aneurysm 2, 5.
- The Society for Vascular Surgery recommends surveillance imaging at 12-month intervals for patients with an AAA of 4.0 to 4.9 cm in diameter 5.
- Patients with larger aneurysms or those who have undergone treatment may require more frequent follow-up and monitoring.
Special Considerations
- Patients with aortic saccular aneurysms may have other co-morbidities, such as aortic stenosis, that require simultaneous treatment 6.
- A multidisciplinary team approach to care can help ensure that all aspects of the patient's condition are addressed and that the best possible outcomes are achieved.