Abdominal Aortic Aneurysm (AAA)

An abdominal aortic aneurysm is an enlargement of the lower part of the aorta that extends through the abdominal area (at times, the upper portion of the aorta in the chest can be enlarged). The aorta is the main blood vessel that carries blood from the heart to the rest of the body. Like most arteries, the aorta is elastic, which allows it to be filled with blood under high pressure. An aneurysm develops when the wall of the artery becomes weakened and distended like a balloon.

The analogy of a bubble in a garden hose would be appropriate in describing an aneurysm. Aneurysms usually are discovered before they produce symptoms, such as back pain, but like the weakened hose, they may rupture if they become too large. Since a ruptured aneurysm is extremely dangerous and can cause life-threatening bleeding, aneurysms are best corrected by an operation before this happens.

 

RISK FACTORS

An abdominal aortic aneurysm (AAA) is a major health risk that may not have related symptoms until a life-threatening event occurs, such as aneurysm rupture. An abdominal ultrasound is a preventive screening tool that can be used to identify an AAA so that prompt treatment can be provided prior to aneurysm rupture.

  • Smoking
  • Heredity
  • Congenital defects, such as an inherited weakness in the blood vessel wall; example, Marfan's syndrome
  • Injury
  • Infection
  • High blood pressure (hypertension). This speeds up damage to blood vessel walls.
  • Arteriosclerosis (also called atherosclerosis). This occurs when the normal lining of the arteries deteriorates, the walls of the arteries thicken, and deposits of fat and plaque block the flow of blood through the arteries. The association of arteriosclerosis with the development of aneurysms is controversial.
  • High cholesterol

SYMPTOMS

Abdominal aortic aneurysms often grow slowly and usually without symptoms, making them difficult to detect. Some aneurysms will never rupture. Many start small and stay small, although many expand over time. Others expand quickly. Predicting how fast an abdominal aortic aneurysm may enlarge is difficult.

 

As an abdominal aortic aneurysm enlarges, some people may notice:

  • A pulsating feeling near the navel
  • Deep, constant pain in your abdomen or on the side of your abdomen
  • Back pain

TREATMENT OPTIONS

Treatment for infrarenal abdominal aortic aneurysms can be performed via two methods which differ greatly in their intra-operative as well as post-operative care. EVAR (EndoVascular Aneurysm Repair) is a procedure through very small incisions in the groin where a graft is inserted into an artery and guided into the aneurysm and excluding flow from the dilated vessel wall. EVAR has a shorter recovery allowing a quicker return to normal activities, is less painful and is overall a newer procedure being performed since the late 1990's. Closer follow up is required with CT scans and/or ultrasounds. Normally the hospital stay is between 1-3 days for this procedure. Open repair requires a large incision in the abdominal midline.

 

The intestines are swept to the side and the aortic aneurysm is surgically opened and a graft is sewn as an interpositional graft. This surgery has been performed for many years and has an excellent long-term follow up with minimal follow-up imaging required. Because of the larger incision, the hospital stay can average from 7-10 days with a higher chance of complications such as peri-operative ileus, pain, heart attack, and even death. Patients should plan to take 4-6 weeks off from work or more. There are large differences between these methods and a discussion should be held with your vascular surgeon regarding which repair is indicated for you.