Aortic Abdominal Aneurysm (AAA)

Dr. Flanagan on computer
Arteries are the tubes carrying blood from the heart to the rest of the body. An aneurysm is a weak area in the wall of an artery that can bulge like a balloon, and can cause problems related to either bleeding or blood clotting. Aneurysms can occur throughout the body, but one of the most common locations is in the aorta. The aorta is the largest artery of the body, carrying blood directly from the heart through the chest and abdomen to the rest of the body.

Aneurysms of the aorta are worrisome because they can burst or rupture resulting in excessive bleeding and usually causing death. A small aneurysm may require no immediate treatment other than "watchful waiting." The aneurysm should be monitored by a vascular specialist who will order periodic ultrasound exams or other tests to make sure that the aneurysm is not growing. Many times aneurysms remain small and pose no significant problems.

If an aneurysm reaches a certain size between 5 and 5.5 cm, your healthcare provider may refer you for aneurysm repair. Aneurysms can be repaired in two ways, depending on the actual dimensions of the aneurysm and relation to surrounding structures, age and health of the individual, willingness to return for regular follow-up, and other factors.

Open Surgical Repair

Direct surgical repair of the aneurysm has been the standard approach for over 50 years. An incision is made in the abdomen, the aneurysm is isolated and opened, and a synthetic graft is sewn to the aorta. The vascular graft is usually made of a polyester type material, and essentially replaces the diseased portion of the aorta. This is a major surgery performed under general anesthesia. Recovery from the operation typically requires 7 to 10 days in the hospital and another 6 to 8 weeks of convalescence at home. Although this is a significant undertaking, results of this operation are generally good, and the chances of further problems are remote.

Endovascular Repair

This procedure has been developed over the past 10–15 years to repair an aneurysm with surgery that is less invasive. Incisions are made in the groins, and a device is maneuvered through the arteries to the area of the aneurysm under x-ray control. The device is deployed within the aneurysm, excluding it from the bloodstream. Recovery following this type of procedure is shorter than with an open repair, typically requiring several days in the hospital and several weeks of convalescence. Only about one-half of aneurysms are of the appropriate size and shape to allow this type of repair. The long term results following endovascular repair are less favorable, and therefore these devices require long term monitoring with CT scanning. This procedure is ideally suited for people with other serious medical problems who may be at increased risk of complications following open repair.

The best treatment for an abdominal aortic aneurysm depends on a number of factors, including the size and location of the aneurysm, whether or not it is causing symptoms, and the age and general health of the patient. Many aneurysms can only be repaired with the open operation. While this is a major operation, the outcomes are generally very good. Other aneurysms may be candidates for either open or endovascular repair. Both approaches have advantages and disadvantages in this circumstance, and you should understand the pros and cons of both approaches before deciding how to proceed. We encourage you to discuss all of these factors and any other questions you have with your primary care provider and vascular specialist.

View video about AAA: