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Abdominal Aortic Aneurysm

(See also Endovascular Stent Graft, Angiogram, Duplex Ultrasound)

What is an abdominal aortic aneurysm?

In humans, the arteries are responsible for carrying oxygen-rich blood from the heart to the rest of the body. The largest of these arteries is called the aorta which runs through the chest (the thoracic aorta), then through the stomach (the abdominal aorta) and then splits into two branches (the iliac arteries) which carry blood into the legs.

When an area of the abdominal aorta weakens (due to high blood pressure, smoking, or other factors) the walls of the aorta expand and bulge outwards.  Unfortunately, as it expands this further weakens and thins the walls of the aorta.   If left untreated, it can eventually rupture causing internal bleeding which will require immediate surgical intervention.

How do I know if I have an abdominal aortic aneurysm?

Although you may initially not feel any symptoms with AAA, if you develop symptoms, you may experience one or more of the following:

  • A pulsing feeling in your abdomen, similar to a heartbeat
  • Severe, sudden pain in your abdomen or lower back. If this is the case, your aneurysm may be about to burst
  • On rare occasions, your feet may develop pain, discoloration, or sores on the toes or feet because of material shed from the aneurysm
  • If your aneurysm bursts, you may suddenly feel intense weakness, dizziness, or pain, and you may eventually lose consciousness. This is a life-threatening situation and you should seek medical attention immediately.

What causes an abdominal aortic aneurysm?

No one is 100% certain as to what causes an abdominal aortic aneurysm to form. The prevailing theory is that it may be caused by inflammation in the aorta which causes its walls to weaken or break down. What is known is there are certain factors which increase your risk of suffering from an AAA in your lifetime:

  • Being a man older than 60 years
  • Having an immediate relative, such as a mother or brother, who has had AAA
  • Having high blood pressure
  • Smoking
  • Your risk of developing AAA increases as you age. AAA is more common in men than in women.

What tests will I need?

Abdominal aortic aneurysms that are not causing symptoms are most often found when a physician is performing an imaging test, such as an ultrasound or CT scan, for another condition. Sometimes your physician may feel a large pulsing mass in your abdomen on a routine physical examination. If your physician suspects that you may have AAA, he or she may recommend one of the following tests to confirm the suspicion:

  • Abdominal ultrasound
  • Computed tomography (CT) scan
  • Magnetic resonance imaging (MRI)

If I have an abdominal aortic aneurysm, how will my physician treat it?

If your AAA is small, then your physician will simply monitor your aneurysm with periodic tests. He or she may also prescribe blood pressure medicine in an attempt to lessen the pressure exerted on the walls of your aorta.

If your AAA expands beyond a certain point, then you may be referred to a vascular surgeon for a procedure called “open aneurysm repair.” During an open aneurysm repair, also known as surgical aneurysm repair, your surgeon makes an incision in your abdomen and replaces the weakened part of your aorta with a tube-like replacement called an aortic graft. This graft is made of a strong, durable, man-made plastic material in the size and shape of the healthy aorta. This tube takes the place of the weakened section in your aorta and allows your blood to pass easily through it.

And then what happens?

Following the surgery, you may need to remain in the hospital 4 to 7 days for recovery and observation.  Depending upon your circumstances (overall health, age, and other factors), you may need up to an additional 3 months for a full recovery. More than 90 percent of open aneurysm repairs are successful for the long term.

Are there any other treatment options?

If your vascular surgeon believes that you are a good candidate, he or she may instead recommend a newer procedure called an endovascular stent graft. Endovascular means that rather than open surgery, the procedure is performed inside your artery using long, thin tubes called catheters that are threaded through your blood vessels. This procedure is less invasive, meaning that your surgeon will usually need to make only small incisions in your groin area through which to thread the catheters. Like the graft in open surgery, the endovascular stent graft also strengthens the aorta.

What’s the difference between the two in terms of recovery?

Your recovery time for endovascular stent grafting is usually shorter than for the open surgery, and your hospital stay may be reduced to 2 to 3 days. However, this procedure requires more frequent follow-up visits with imaging procedures, usually CT scans, after endograft placement to be sure the graft continues to function properly. Also, the endograft is more likely to require periodic maintenance procedures than does the open procedure.

I’d like to spend less time in the hospital… can I simply request the endograft over surgery?

Not all patients are candidates for endovascular repair. Your aneurysm may not have a shape which is suitable for this procedure, or it may not be a suitable option due to the extent of the aneurysm, or its relationship to the renal (kidney) arteries, or other issues. While the endovascular stent graft may be a good option for some patients who have suitable aneurysms and who have medical conditions increasing their risk, in some other cases, open aneurysm repair (surgery) may still be the best way to cure AAA. Your vascular surgeon will help you decide what is the best method of treatment for your particular situation.

For more information, please visit Vascular Web, Provided by the Society for Vascular Surgery.