Abdominal Aortic Aneurysm

New Treatment Speeds Recovery 

An Abdominal Aortic Aneurysm, or AAA, is an abnormal enlargement or bulge in the abdominal section of the aorta, the body’s largest artery that carries blood from the heart to all parts of the body. An aneurysm can cause the aorta to grow to several times its natural size, weakening it, and possibly causing it to rupture. 

Until the last decade, invasive surgery was the primary recourse to prevent abdominal aortic aneurysms from becoming deadly. A less-invasive technique called endovascular stent graft repair, however, is changing the treatment protocol and resulting in less blood loss, fewer days of hospitalization and a potentially faster recovery time for patients with AAA. 

Open Surgery 

In conventional or open surgery, the surgeon reaches the aneurysm through a large incision in the abdomen. The weakened section of the vessel, where the aneurysm has formed, is usually surgically removed and replaced with a synthetic material. Open surgery is usually performed under general anesthesia and takes about four to five hours to complete. Repairing the aneurysm surgically is complex and requires an experienced vascular surgical team. After surgery, the patient usually stays in the Intensive Care Unit a day or two, and then another five to seven days in the hospital. The full recovery time may be about three to six months.

Endovascular Stent Graft Repair

Endovascular Abdominal Stent-Grafting was invented in the early 1990s as a less-invasive endovascular method of repair of an abdominal aortic aneurysm and has rapidly expanded as the treatment of choice due to its clinical benefits. 

The procedure involves two skin punctures or small incisions in the groin area, where the stent-graft is inserted into the femoral artery through a catheter to reline the abdominal aorta. The stent graft is a woven fabric tube supported by a tubular metal scaffold. The device is placed inside the diseased abdominal aorta without a major surgical incision and seals off the aneurysm by fitting inside the diseased part of the aorta, making a new path for blood to flow. 

The procedure can be done under general, regional or local anesthesia and typically takes one to two hours to complete. The hospital stay is generally one to two days, and patients can expect to resume normal activities in one to two weeks after the procedure. Regular follow-up is needed to evaluate and ensure the success of the stent graft treatment over time. The endovascular treatment of AAA has become the treatment of choice at McKay-Dee Hospital, where surgeons have been performing this procedure successfully for the past 10 years. 

Risks and Symptoms for Aortic Aneurysm 

Abdominal aortic aneurysms are most often caused by a weakening in the aortic wall, resulting from vascular disease, traumatic injury or a genetic defect. In addition, as we age, high blood pressure can cause the aorta to bulge out, thin and weaken, resulting in an aneurysm. Men older than 60, smokers, and those with a family history are most at risk. 

The risk of an abdominal aortic aneurysm increases for patients who: 

• Smoke. 

• Have high blood pressure. 

• Have high cholesterol. • Are overweight. 

• Have a family history of aneurysms, cardiovascular or peripheral vascular disease (narrowing of the blood vessels). 

Abdominal aortic aneurysms may go unnoticed initially because patients may not feel any symptoms. Frequently, an AAA is discovered incidentally on an imaging study such as an abdominal ultrasound or CT scan of the abdomen. 

When symptoms are experienced, the most common are: 

• Pain in the abdomen, chest or lower back, possibly spreading to the groin, buttocks or legs. The pain may be deep, aching, gnawing and/or throbbing, and may last for hours or days. It is generally not affected by movement. 

• A pulsating sensation in the abdomen. 

• Back pain, if the aneurysm is pressing on the spine. 

• A “cold foot” or a black or blue painful toe if an AAA produces a blood clot that breaks off and blocks blood flow to the legs or feet. 

• Fever or weight loss, if the AAA is an inflamed/infected aortic aneurysm.