What does ligating an arterial aneurysm mean?

From the Guidelines

Ligating an aneurysm means surgically tying off a weakened, bulging section of a blood vessel to prevent it from rupturing, which is achieved by placing a surgical suture or clip around the neck or base of the aneurysm to isolate it from normal blood circulation. This procedure involves cutting off blood flow to the aneurysm, preventing blood from entering and expanding the weakened area, significantly reducing the risk of rupture and potentially fatal bleeding 1.

Key Points

• The technique is most commonly used for cerebral aneurysms (in the brain) and aortic aneurysms (in the main artery from the heart)
• Ligation works by creating a physical barrier that allows the body to eventually reabsorb the isolated aneurysm while maintaining normal blood flow through the healthy portion of the vessel
• Although ligation is considered a definitive treatment for many aneurysms, it has been largely replaced by less invasive techniques such as endovascular coiling or stenting for many types of aneurysms, as shown in the guidelines for the management of patients with unruptured intracranial aneurysms 1.

Considerations

• The use of coil embolization increased substantially after publication of the results of the International Subarachnoid Aneurysm Trial (ISAT) in 2002 and 2005, which showed improved clinical outcomes in the coiling arm at 1 year 1
• Carotid ligation was commonly used to treat recently ruptured intracranial aneurysms before 1970, but its use has decreased due to the high number of intervention failures and rebleed rates, as demonstrated by a large retrospective study by Nishioka 1
• Long-term follow-up has shown a benefit for carotid ligation in reducing rebleeding at 3 years and mortality at 5 years, but the rate of treatment failures likely exceeds that of direct surgical treatment of the aneurysm 1

From the Research

Definition of Ligation

• Ligation of an aneurysm refers to the surgical procedure of clipping or tying off the aneurysm to prevent further bleeding or rupture 2, 3.
• This procedure is often performed using a microneurosurgical clip to occlude the aneurysm and prevent blood flow into it 2.
• Ligation can be performed alone or in combination with other treatments, such as endovascular coiling or flow diversion 2, 4, 5.

Purpose of Ligation

• The primary purpose of ligating an aneurysm is to prevent re-bleeding and reduce the risk of further complications 2, 4, 5.
• Ligation can also help to decompress the injured brain and reduce the risk of aneurysm recurrence 2.
• In some cases, ligation may be used in combination with other treatments to maximize the benefits and minimize the risks of each approach 2, 4, 5.

Techniques and Approaches

• There are different techniques and approaches to ligating an aneurysm, including microneurosurgical clipping, endovascular coiling, and flow diversion 2, 4, 6, 3, 5.
• The choice of technique and approach depends on various factors, including the location and size of the aneurysm, the patient's overall health, and the surgeon's preference 2, 4, 6, 3, 5.
• In some cases, a combination of techniques and approaches may be used to achieve the best possible outcome 2, 4, 5.