Abdominal and Thoracic Aortic Aneurysm

People with aortic aneurysms – thoracic or abdominal – may need to be operated on an urgent basis. It is for this reason that abdominal and thoracic aortic aneurysm surgery abroad in countries with no wait times like India is sometimes preferred. In many cases, high cost is what leads people to go abroad for this procedure.

An aortic aneurysm is an abnormal bulge in the aorta wall. The aorta is the largest artery in the human body: it carries oxygenated blood from the heart down through the chest and abdomen, where it divides into a blood vessel that supplies each leg.

An aortic aneurysm can result in a life-threatening situation because it may rupture and cause internal bleeding. The risk of an aneurysm rupturing increases with its size and location.

An aneurysm can form anywhere along the aorta, but is most often formed in the abdominal and the thoracic regions. The location of the aneurysm determines the treatment method to be employed.

What Causes Abdominal or Thoracic Aortic Aneurysms?

Abdominal aortic aneurysms are rare in people below 60. About one in 1,000 persons develops an abdominal aortic aneurysm after 60, and this number increases with age. Men are more prone to aortic aneurysms than women. But very few aneurysms are actually large enough to warrant surgery.

Apart from age, there are some factors that increase the risks of developing aortic aneurysms. They are:

• Smoking
• Caucasians are more susceptible to aortic aneurysms than other groups.
• People with coronary heart disease and peripheral vascular disease may develop aortic aneurysms. (Peripheral vascular surgery is necessitated when there is a narrowing of the blood vessels outside of your heart. Fat and cholesterol build up on the walls of the arteries and block the arteries. This can reduce or stop blood flow, usually to the legs, causing them to hurt or feel numb. Debris or plaque from aneurysms can also cause blocks in the arteries.)
• A family history of aortic aneurysms.
• Marfan syndrome may cause thoracic aortic aneurysms. Marfan syndrome is a genetic condition that affects the connective tissue in the body. People who have it have a weak aortic wall, which may cause aneurysms.

What are the Symptoms of Aortic Aneurysms?

Aortic aneurysms are usually asymptomatic and are discovered during routine check-ups or during chest X-rays or computerized tomography (CT) scan done for some other condition. Some symptoms that may show up because of the aneurysm pressing on nearby organs are intense pain in the chest or back, stroke, cold or numb extremities, or abdominal pain. Sometimes, patients with abdominal aortic aneurysms may notice a pulsating mass in their abdomen.

Nerve decompression surgery:

External Neurolysis

Nerves in our body tend to cross across muscles and bones and occasionally tend to get trapped due to scarring or fibrosis, causing pain due to nerve irritation, when the limb is moved. The procedure involves the removal of the scar tissue formed around the nerve without entering the nerve.

Internal Neurolysis

The procedure is used when there is internal scarring and swelling in the nerve tissue. In such cases the outer sheath covering the nerve is opened and the scar tissue inside is removed to reduce pain and irritation.

There are the two basic techniques of conducting decompression surgery. The first one is open nerve release, which involves decompressing the nerve tissue through an incision in the skin. The second technique is an endoscopic method, where a tube containing a camera is passed, through a small incision into the affected area and the compression assessed. The procedure of decompression is then conducted. The latter procedure has an advantage of reducing the recovery time and allowing the patient to return back to work at the earliest.

Surgery for Nerve Injuries

Nerve Repair

A procedure that involves re-attaching the two ends of the torn nerve with fine sutures with the help of a microscope. This is possible only when there is no nerve tissue lost as a result of the injury

Nerve Grafting

A procedure, which involves the use of a graft (most often used is the sural nerve from behind the calf). The graft is attached to the injured nerve in the same way as done in the nerve repair procedure. The patient may suffer from temporary numbness in the calf region, which usually resolves after 6-8 months

Conduit Nerve Repair

When the gap is less than 2-3 centimeters, instead of using a nerve grafting procedure, a small absorbable tube is used. As an alternative a vein conduit can also be used, this is equally effective. Conduits may be used to cover or wrap the nerves to protect them from scar tissue in the surrounding area.

Transfer surgery

On few occasions, the above procedures are not adequate to re-instate the normal functioning of the muscle, tendon or the nerve. In such cases transfer of other nerves, muscle or tendons ( which are less frequently used or have multiple controlling nerve supplies) are used

Nerve Transplant

A rarely used procedure which involves transfer of nerve tissue from other patient.

Surgery for Nerve Tumors

Management of nerve tumors involves the excision of the benign or cancerous cells by the oncologist. During the procedure all precautions are taken to ensure minimum damage to the nerve tissue and its functions.

Preoperative Management: Peripheral Nerve Surgery

• A physical evaluation and assessment of the patient is done to verify the urgency and severity of managing the clinical condition. This physical evaluation will include sensory evaluation (which will consist of, the two point discrimination test and light touch test) and Motor assessment (which will include pinch and grip strength measurement and muscle strength measurement).
• Radiological scans like MRI, CT or other studies would be conducted depending upon the condition, to confirm the diagnosis.
• The surgery may be conducted under general anesthesia on IPD basis or under local anesthesia on OPD basis depending upon the severity of the condition and the nerve involved.

Post-operative Care: Peripheral Nerve Surgery

• In a peripheral nerve surgery conducted on OPD basis, the patient is discharged within a couple of hours on the same day.
• For procedures which are conducted on IPD basis, the patient is hospitalized for a few days after the procedure. The dressing is removed 2-3 days after the procedure.
• The patient is recommended several physical exercises to enhance the mobility of the joints. These exercises are aimed at maintaining the functionality of the unaffected muscles at the initial stages after the surgery and subsequently to regain the sensory and motor functions of the affected nerve.

Complications: Peripheral Nerve Surgery

Complications of peripheral nerve surgery are similar to complications associated with similar nature of surgeries which include infection, hematoma, injury to surrounding tissues, etc. There is also a possibility that the surrounding nerves may be injured during the surgical intervention which can further deteriorate the functionality of the affected organ.

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