Abdominal Aortic Aneurysm

An abdominal aortic aneurysm (AAA) is a localized dilation or bulge in the abdominal segment of the aorta, the largest artery in the body. If left untreated, the aneurysm can rupture and lead to life-threatening bleeding. Treatment options for AAA depend on the size and characteristics of the aneurysm and may include surgical repair or monitoring with regular imaging.

Common symptoms can include sudden stabbing, radiating pain, fainting, difficulty breathing, and sometimes sudden weakness on one side of the body could suggest an aortic event. Clammy skin, nausea and vomiting, or even shock are also common accompanying symptoms. Aortic disease can also mirror symptoms of a heart attack, such as chest pain or jaw pain. The aorta spans from above the heart all the way down to below the navel, so symptoms of pain can occur at any place along the torso.

 

Causes

Genetics and family history of aortic disease contribute significantly to the risk of developing an aortic aneurysm or dissection. In addition to genetic factors and age, people who experience the conditions below have an increased risk of aortic disease.

• High blood pressure: The increased force of blood can weaken the artery walls
• Marfan syndrome or other genetic conditions: These factors can cause problems with the body’s ability to make healthy connective tissue
• High cholesterol or atherosclerosis: A buildup of plaque may increase inflammation in and around the aorta and other blood vessels
• Inflamed arteries: The body’s blood vessels can become inflamed due to trauma from car accidents or certain diseases like vasculitis
• Smoking: People with a history of smoking are three to five times more likely to develop an aortic aneurysm

 

Treatments

If identified early, aortic disease can be managed medically with frequent monitoring, medication and adjustments in lifestyle.

Surgical treatment options include minimally invasive procedures (referred to as endovascular repair), or open repair. Surgical treatment is intended to reconstruct or replace the affected area of the aorta. Such surgical procedures include the placement of a stent or stent-graft, which can be placed through open repair, endovascular repair (minimally invasive), or a hybrid approach combining the two. The most common treatment modalities are open repair of ascending aorta for type A dissection, and thoracic endovascular aortic repair (TEVAR) for type B dissection.

 

• Open Abdominal Aortic Aneurysm Repair (AAA): During this procedure, the abdominal segment of the aorta is replaced with a prosthetic tube graft through an open incision. This procedure requires general anesthesia.  The hospitalization period is 5-7 days and full recovery can take a few weeks.  The Department’s outcomes are among the best in the country.
• Endovascular Abdominal Aneurysm Repair (EVAR): The minimally invasive endovascular abdominal aneurysm repair (EVAR) procedure involves making small incisions in the groin and threading catheter tubes through the femoral arteries and into the aorta. A fabric-covered metal stent is introduced through the artery and fixed in place, relieving pressure on the artery to prevent rupture. Patients remain conscious under local anesthesia during the procedure. Patients who undergo EVAR have lower morbidity rates and shorter recovery times and can usually resume normal activity within a few days after surgery.

 

Before the Procedure

Before undergoing AAA repair, a thorough evaluation is conducted, including a review of medical history, physical examination, and imaging tests (such as ultrasound, CT scan, or MRI). The care team will discuss the treatment options, potential risks, benefits, and answer any questions or concerns.

 

During the Procedure

EVAR and AAA are performed under general anesthesia or local anesthesia with sedation. The procedure involves the following steps:

• Access: Small incisions are made in the groin to access the femoral arteries.
• Stent Graft Placement: Guided by X-ray imaging, a catheter carrying the stent graft is inserted through the incision and advanced to the aneurysm site. The stent graft is positioned within the aneurysm and deployed, creating a new channel for blood flow while excluding the weakened segment.
• Completion and Recovery: Once the stent graft is securely in place, the catheter is removed, and the incisions are closed. The patient is monitored in a recovery area before being transferred to a hospital room.

 

After the Procedure

After the procedure, patients are closely monitored in the hospital to ensure stable vital signs and proper recovery. The healthcare team will provide pain medication, monitor incision sites, and manage any potential complications.

 

Risks and Complications

While these procedures are generally considered safe, potential risks and complications include:

• Endoleak: Occurs when blood continues to flow into the aneurysm after the stent graft placement.
• Graft Migration or Collapse: The stent graft may shift out of position or collapse, potentially affecting blood flow.
• Infection: Infection at the incision sites or around the graft can occur, although it is relatively rare.
• Renal Complications: Decreased blood flow to the kidneys may occur in some cases.

 

Typical Recovery Time

The recovery time varies depending on the individual patient, the complexity of the procedure, and any associated complications. The full recovery period may range from a few weeks to several months.

 

Results and Post-Procedure Care

Post-procedure care may involve regular follow-up appointments with imaging tests to monitor the stent graft’s position and aneurysm size, blood pressure management, and adopting a heart-healthy lifestyle, including regular exercise, a balanced diet, and smoking cessation.

 

If you have specific concerns about a procedure or your health, please consult a physician.

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