What is an abdominal aortic aneurysm (AAA)?
The aorta is a large blood vessel that comes off the heart and runs through the chest and then into the abdomen. At around the belly button it splits into 2 vessels that carry blood to the legs. When a section of the abdominal aortic wall becomes weak, it can expand. This is an abdominal aortic aneurysm or AAA. The pressure from the blood moving through this area can cause the wall to continue to expand. The normal diameter of the aorta is about 2 centimeters, but when an aorta is aneurysmal, it can expand to a dangerous diameter. The major concern of AAA is rupture, when the aneurysm breaks open. This is not the only concern though. Clots can build up inside the aneurysm and travel to other parts of the body.
What are the symptoms?
A patient usually will not have any symptoms. Some of the symptoms that may occur include a pulsing feeling in the abdomen or severe or sudden pain in the abdomen and/or lower back. Because of the lack of symptoms, a AAA is usually incidentally found during testing for another health problem.
What testing will be performed?
If a AAA is suspected, your doctor may recommend one of the following tests.
What is the treatment for a AAA?
Once diagnosed with a AAA, watchful waiting is usually the treatment while keeping other conditions such as high blood pressure and high cholesterol under control. Your physician will schedule an ultrasound or CT scan every six months to a year to follow the growth of the aneurysm. This will continue until the diameter reaches >5cm. At this time intervention may be recommended.
When it is time for intervention there are a couple of different options depending on your medical history and current health conditions. The two treatment options are open surgical repair and endovascular stent graft.
The endovascular stent graft procedure is less invasive, meaning that your surgeon will need to make only small incisions in your groin area through which to thread the catheters. During the procedure, your surgeon will use live x-ray pictures on a video screen to guide a fabric and metal tube, called an endovascular stent graft (or endograft), to the site of the aneurysm. Like the graft in open surgery, the endovascular stent graft also strengthens the aorta. Your recovery time for endovascular stent graft is usually shorter than the open surgery, and your hospital stay may be reduced to 2 to 3 days. However, this procedure requires more frequent imaging procedures after placement to be sure the graft continues to function properly, and is more likely to require periodic maintenance than the open procedure. In addition, you may not be suitable to have this procedure, since not all patients are candidates for endovascular repair because of the extent of the aneurysm, its relationship to the renal (kidney) arteries, or other issues.
During an open aneurysm repair, also known as surgical aneurysm repair, your surgeon makes an incision in your abdomen and replaces the weakened part of your aorta with a tube-like replacement called an aortic graft. This graft is made of strong man-made material, such as plastic, in the size and shape of the healthy aorta. The strong tube takes the place of the weakened section in your aorta and allows your blood to pass easily through it. Following the surgery, you may stay in the hospital for 4 to 7 days. You may also require 2 to 3 months for a complete recovery. More than 90 percent of open aneurysm repairs are successful for the long term.