Surgical Repair of an Abdominal Aortic Aneurysm
Spring 2005
An abdominal
aortic aneurysm (AAA) is a weakened area of the aorta, the main
artery that supplies blood from the heart
and extends down to the abdomen.
Pressure from the blood flowing through
the aorta can cause the weak area to
bulge, and possibly burst if the aneurysm
becomes too large.
The most common cause of an
AAA is atherosclerosis, or hardening of the arteries.
This occurs when fatty substances, such
as cholesterol, build up in the artery wall
causing the wall to weaken and bulge.
Men over the age of 60 who have smoked,
or have a history of hardening of the
arteries, are at the highest risk for developing
an AAA. Also, those with a family history
of this condition are at a higher risk,
especially if the relative was female.
Usually,
there are no obvious symptoms of this disease,
which is why AAA is sometimes referred to as
the “silent killer.”
However, if symptoms are present, they
would include abdominal pain, pain in the
lower back, groin or legs, or the feeling of
a pulse, or “heartbeat” in the abdomen.
Sudden, severe abdominal or back pain
may be a sign that the aneurysm has
burst, and immediate medical attention
is needed.
Most abdominal aortic aneurysms
are initially diagnosed during a routine
physical examination. The doctor may
feel a soft mass, which pulses with each
heartbeat, in the abdomen, and may
suggest further testing to confirm the
diagnosis. An abdominal ultrasound is
a common method used to diagnose an
AAA. Other tests include an abdominal
X-ray, an MRI of the abdomen or a CT
scan of the abdomen.
Often, for small aneurysms (less than
5 cm) that are not growing or causing
symptoms, no treatment is required,
other than a periodic evaluation to
watch for any changes. Aneurysms
greater than 5 cm in diameter or those
causing symptoms usually require
surgical repair.
There are two surgical options
available to repair an abdominal aortic
aneurysm — the open procedure and
the minimally invasive technique called
endovascular aortic stent grafting.
Open surgical repair requires an incision
through the abdominal wall in which the
damaged area is replaced with synthetic
tubing. With this procedure, you can
expect to be in the hospital for about
one week, and should be able to return
to normal activity approximately six to
eight weeks following surgery.
For those who prefer
bloodless surgical techniques, an endovascular
aortic stent graft may be the best option.
This minimally invasive technique requires no
abdominal surgical incision, allowing for decreased
blood loss, a faster recovery and a
shorter hospital stay for the patient.
However, this type of procedure is not
right for everyone.
Approximately 25 to 50 percent
of patients are not eligible for
endovascular aortic stent grafting
because of their anatomy. The stent
grafts are not customized for each
patient’s anatomy, and are only
made in certain sizes.
To determine
eligibility, a patient must go through
a series of tests, which usually
includes a CT scan and sometimes
an arteriography (X-ray taken to see
if the arteries are damaged). If a
patient is not eligible for the minimally
invasive technique, open surgery
would be performed using bloodless
techniques. Currently, the endovascular
aortic stent graft is only available for
non-emergency repair.
If you are diagnosed with an
abdominal aortic aneurysm that
requires surgical repair, talk with your
physician about which surgical option
is right for you.
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