What is an Abdominal Aortic Aneurysm?

An abdominal aortic aneurysm (AAA) occurs when the portion of the aorta passing through the abdomen is weakened and begins to bulge. Usually, this occurs in the region just below the kidneys. The condition is fairly common in older adults and is more common in men than in women. Aneurysms are most often caused by atherosclerosis (a buildup of plaque and cholesterol in the arteries). High blood pressure and smoking are risk factors.

There are no specific symptoms for an AAA, except some patients with advanced cases may experience some throbbing in the abdomen or lower back pain. Therefore, many such aneurysms are never diagnosed until it is too late. Many AAAs are discovered by accident when the patient has a physical examination or, for some other reason, undergoes tests such as an x-ray, ultrasound, CT scan, or MRI.

When an aneurysm is detected, consultation with a vascular specialist is required to determine whether treatment is needed. If small, an aneurysm may be monitored periodically. When an aneurysm is large, treatment is needed to prevent rupture. (Aneurysms may develop very slowly over many years.) A ruptured aorta is life-threatening. Less than half of those who experience an aortic rupture survive.

Treatment Options for AAA

Treatment is usually not needed until an aneurysm is more than 2 inches in diameter. (The Normal aorta is about one inch.) The procedure may be done in one of two ways: (1) a standard "open" procedure involving an abdominal incision, or (2) an endovascular procedure using catheters to avoid major surgery. In both cases, a graft (essentially a hollow tube) is inserted in place of the damaged artery to prevent rupture. In a traditional open abdominal surgery to repair an abdominal aortic aneurysm, the procedure is performed under general anesthesia. First, an incision is made and the muscles and internal organs are gently retracted to allow access to the aorta, which is located near the spine. The surgeon removes the damaged, weakened portion of the blood vessel and replaces it with a synthetic graft. 

* The Illustrations above describe the Surgical Repair of AAA

What is Endovascular Repair of AAA?

Recent advances allow our physicians to perform an endovascular procedure that is much less invasive and requires significantly less recovery time. This approach uses a specially-designed graft that is placed inside the aneurysm. Instead of opening the abdomen, the new graft is inserted through two small incisions in the groin. Thin tubes (catheters) are used to guide the new graft through the abdomen to the aneurysm site. The graft is inflated and anchored to the normal, healthy artery above and below the diseased portion. This keeps the blood from pushing against the weakened arterial wall, which allows the aneurysm to slowly shrink back to near normal size over a period of four to six months. 

Compared to open surgery, patients who undergo an endovascular repair procedure experience substantially less blood loss, are less likely to require a transfusion, spend less time In intensive care, require shorter hospital stays, and recover more quickly when treated with stent-graft therapy. CTVS surgeons discuss the risks and benefits of stent-graft therapy with all candidates for AAA Repair. 

Following Treatment

Patients undergoing a surgical repair of an AAA typically stay in the hospital for about five to seven days following the surgery (including one or two days in the intensive care unit) and should expect full recovery within two months. If an endovascular method is used to treat the AAA, patients should expect to remain in the hospital for two to three days following the procedure. Full recovery may take an additional week.
Once treated, abdominal aortic aneurysms generally do not recur.