An aneurysm is an abnormal dilation or local out pouching of an artery. This results from a weakening in the substance of the arterial wall. The most common location for an aneurysm is in the aorta, the body’s largest artery, as it passes within the abdomen. As it enlarges, it may reach a point at which the wall of the artery tears open, resulting in massive internal bleeding which will cause sudden abdominal and back pain. This condition is fatal unless an emergency surgery is performed.
Abdominal aortic aneurysm (AAA) usually causes no problems to the patient until it ruptures. Consequently, it is important to identify the patient with an AAA and to repair the aneurysm before it ever causes pain or ruptures.
An AAA may be identified by a pronounced pulsation in the middle of the upper abdomen. The physician may identify this on a physical exam. However, the majority of AAA’s are found on an x-ray (such as an ultrasound, CT scan, or back x-ray).
Risk Factors
- AAA occurs more commonly in men then women.
- These patients are usually older than 60 years and have smoked cigarettes.
- Many also suffer from coronary artery disease (heart disease), peripheral arterial disease (arterial blockage at other locations), hypertension, or lung disease.
- One has between a good chance of developing an AAA if a first degree relative (father, mother, brother, or sister) has had an AAA.
Diagnosis
- Ultrasound scan of the abdomen is very effective at identifying the presence of an AAA and its size.
- Men over the age of 60 with a history of smoking should be screened for an AAA with ultrasound.
- A man over the age of 60 with a family history of an AAA.
- Once an AAA is identified, it is important to measure its maximum width.
- AAA has a very low risk of rupturing when under 5 cm in width. Your vascular surgeon may forestall the surgical repair of your AAA and monitor its status with ultrasound until it reaches a width of 5.5 cm, as long as the aneurysm is not painful or growing at a rapid rate.
Treatment
There are two methods of repair:
1. Open surgical approach
2. Minimally invasive surgery or endovascular repair
The open surgical approach involves making a large incision into the abdomen in order to expose the aorta and its aneurysm. Clamps are applied to the arteries above and below the aneurysm so that the artery may be directly cut open. The section of artery that is abnormally enlarged is replaced by a synthetic tube, which the surgeon sews into place. The clamps are removed and blood flow is restored through the repaired artery. This surgery has great success. However, it is major surgery.
Recent advances in minimally invasive surgery have made the endovascular repair of an AAA possible. Incisions are made in each leg in the groin, where the arteries at these locations are exposed. Under x-ray guidance, a device is inserted into the aorta and aneurysm from the arteries in the groin. This device is a stent covered with a fabric. Once inserted into the proper position, this stent graft replaces the abnormal section of aorta from within. The successful insertion of an aortic endograft by the surgeon has less operative stress on the body, no painful abdominal incision, less blood loss, a lower operative mortality, reduced length of hospital stay and much faster recovery when compared to the open surgical approach.
This silent killer is largely preventable by early identification.
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