Treatment of Thoracic Aortic Aneurysm in Germany
Best hospitals and doctors for thoracic aortic aneurysm treatment in Germany
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An aortic aneurysm is a local enlargement of the blood vessel. This disease usually progresses. It often leads to life-threatening complications such as aortic dissection and rupture. The aortic rupture causes a massive hemorrhage, and only 5% of patients can be saved. Therefore, it is worth treating the aneurysm on time to avoid complications. In Germany, small aortic aneurysms are treated with the use of the endovascular technique – from the inside of the blood vessels, through an incision in the groin. In complex clinical cases, as well as in large diameters of the enlarged section of the aorta, doctors resort to open surgery with an incision on the thorax.
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Whenever possible, the aneurysm is treated using minimally invasive surgery – endovascular aortic prosthetics. If this is not possible, based on the clinical case, then open surgery is performed.
How is an aneurysm diagnosed?
An aneurysm is often detected only with the development of complications since in 75% of cases it does not cause any symptoms. In addition, it can be detected by chance, during examination for another disease.
In 25% of cases, a thoracic aortic aneurysm is accompanied by the following clinical symptoms:
- palpitations;
- dyspnea;
- dizziness;
- swelling of the head and neck;
- decreased heart rate;
- swallowing disorders are possible.
In the case of aortic dissection, pain appears behind the sternum, which is similar to an attack of angina or myocardial infarction.
A doctor may suspect an aneurysm by measuring blood pressure in the upper and lower extremities. It is usually lower in the lower extremities, but in patients with aneurysms, it is the same as in the arms or higher.
Doctors find half of the aneurysms on X-ray scans taken for other conditions, such as pneumonia.
Computed tomography is the most effective examination for the targeted diagnostics of an aneurysm. Doctors can detect enlargements, measure them, and detect vessel wall dissection and blood clots. Every fourth patient has more than one aneurysm.
Other tests that are less commonly used are as follows:
- echocardiography;
- angiography;
- MRI.
Conservative therapy
Conservative therapy is conducted only for small aneurysms to reduce the risk of complications and slow down the progression of the disease. It is indicated to patients who have no indications for surgery.
The goal of treatment is to reduce the hemodynamic load on the affected section of the blood vessel. For this purpose, doctors use the following medications:
- beta-blockers;
- ACE inhibitors (angiotensin-converting enzyme);
- calcium channel blockers.
Since atherosclerosis is one of the main causes of aneurysm development, patients receive statins to lower blood cholesterol levels.
Surgical treatment
Radical thoracic aortic aneurysm treatment in Germany involves surgical interventions. They are performed not only through an incision in the thorax, but also from the inside of the blood vessels – an endovascular technique. Such surgical interventions are more sparing. They provide a quick recovery, a low risk of complications, and a reduced period of hospital stay.
Indications for surgical treatment of ascending thoracic aortic aneurysm are:
- Marfan's syndrome and risk factors for complications when the maximum aneurysm diameter is 4,5 cm;
- bicuspid valve lesion and risk factors – in the aneurysm size of 5 cm;
- without congenital diseases and risk factors – the operation is indicated for aneurysms from 5,5 cm.
In the case of the aortic arch and its descending part pathology, the operation is performed for an aneurysm from 5,5 cm. If a woman is planning a pregnancy, it is advisable to repair even at a size of 4 cm or more to avoid dissection.
Thoracic endovascular aortic repair (TEVAR) is one of the main treatment methods in Germany. The doctor makes an incision in the leg, inserts a catheter, and performs all the necessary manipulations from the inside of the vessels. The procedure is performed under X-ray guidance. The doctor delivers a stent-graft to the inside of the aorta. This is a cylindrical frame. It looks like a mesh covered with a shell on top. A stent- graft is placed inside the aorta and blood now flows through it. As a result, there is no longer any threat of aortic dissection or aortic rupture. With the proper selection of patients, minimally invasive treatment of the thoracic aorta aneurysm is not inferior in terms of the effectiveness of open surgery. Both immediate and distant results are comparable.
Open prosthetics are surgery performed through an incision in the thorax. It is required if:
- the patient is admitted to the hospital with complications;
- the aortic aneurysm is located in an inconvenient place for endovascular prosthetics;
- the patient has Marfan's syndrome;
- the diameter of the aneurysm exceeds 6 cm;
- the endovascular procedure is impossible for technical reasons (lack of equipment and experienced surgeons).
When performing open surgery, the doctor can completely remove the pathologically enlarged section of the blood vessel and replace it with a prosthesis. Less commonly, the aneurysm is wrapped with a mesh prosthesis on the outside. Sometimes the doctor creates an anastomosis – a pathway for blood flow bypassing the area with the aneurysm.
During the operation, surgeons often have to eliminate aneurysms in several parts of the aorta at once. Besides, additional intervention on the brachiocephalic and coronary arteries and the aortic valve may be required.
If you want to find out how much is the diagnostics and treatment of thoracic aortic aneurysm in Germany, you are welcome to use the Booking Health service. You can find the best clinics in Germany on our website and the cost of treatment with the use of different methods. You have the opportunity to compare prices in different hospitals in order to book a medical care program at a favorable price. Please leave your request on our website to get a consultation. The Booking Health specialists will take care of the organization of your trip to Germany for treatment.
Authors:
The article was edited by medical experts, board certified doctors Dr. Nadezhda Ivanisova and Dr. Farrukh Ahmed. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!
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