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Abdominal Aortic Aneurysm

An abdominal aortic aneurysm (AAA) is an abnormal dilation of an artery. This results from a weakening in the substance of the arterial wall. The most common location for an aneurysm is in the aorta, the body’s largest artery, as it passes within the abdomen. As it enlarges, it may reach a point at which the wall of the artery tears open, resulting in massive internal bleeding which causes sudden abdominal and back pain. This condition is fatal unless emergency surgery is performed.

AAA usually causes no problems to the patient until it ruptures. Consequently, it's important to identify and to repair the aneurysm before it ever causes pain or ruptures.

An AAA may be identified by a pronounced pulsation in the middle of the upper abdomen. The physician may identify this on a physical exam. However, most AAA’s are found on an x-ray, such as an ultrasound, CT scan, or back x-ray).

Risk Factors

  • AAA occurs more commonly in men than women.
  • Patients are usually 60 years or older and have smoked cigarettes.
  • Many also suffer from heart disease, peripheral arterial disease (arterial blockage at other locations), high blood pressure, or lung disease.
  • You have a good chance of developing an AAA if your father, mother, brother, or sister has had an AAA.

Diagnosis

  • Ultrasound scan of the abdomen is very effective at identifying the presence and size of an AAA.
  • Men over age 60 with a history of smoking and/or a family history of AAA should be screened for an AAA with ultrasound.
  • Once an AAA is identified, it is important to measure its maximum width as it has a very low risk of rupturing if under 5 cm wide. Your vascular surgeon may forestall the surgical AAA repair and monitor its status with ultrasound until it reaches a width of 5.5 cm, as long as the aneurysm is not painful or growing at a rapid rate.

Treatment - Two Methods of AAA Repair

Open Surgical Approach

The open surgical approach involves making a large incision in the abdomen to expose the aorta and its aneurysm. Clamps are applied to the arteries above and below the aneurysm so that the artery may be directly cut open. The section of artery that is abnormally enlarged is replaced by a synthetic tube, which the surgeon sews into place. The clamps are removed and blood flow is restored through the repaired artery. This surgery has great success. However, it is major surgery.

Minimally Invasive Surgery or Endovascular Repair

Recent advances in minimally invasive surgery have made the endovascular repair of an AAA possible. Incisions are made in each leg in the groin, where the arteries at these locations are exposed. Under x-ray guidance, a stent device is inserted into the aorta and aneurysm from the arteries in the groin. Once inserted into the proper position, this stent graft replaces the abnormal section of aorta from within.

The successful insertion of an aortic endograft by the surgeon has:

  • less operative stress on the body
  • no painful abdominal incision
  • less blood loss
  • a lower operative mortality
  • reduced length of hospital stay
  • faster recovery compared to traditional open surgery.