Abdominal Aortic Aneurysms:

An aneurysm is a balloon-like bulge in a blood vessel which is generally caused by damage to the lining of the blood vessel wall. The most common artery to develop an aneurysm is the aorta. Arising directly from the heart and extending through the chest into the abdomen, the aorta is the largest artery in the body and supplies all of the remaining arteries with blood. Aortic aneurysms may form anywhere along the aorta but are most commonly seen in the abdomen (abdominal aortic aneurysm) and the upper body or chest region (thoracic aortic aneurysm). It is important to identify and treat AAA thoroughly to avoid rupture. The survival rate from ruptured AAA is less than 25% and is a major cause of death.

Symptoms

Most aortic aneurysms are silent and do not cause symptoms until they rapidly expand or rupture. When symptoms do present, it may feel like a pulsing pain near the navel, a throbbing or deep pain in one’s back or side or pain in the buttocks, groin or legs. In order to detect an aneurysm it is important to conduct screenings in people who have the risk factors.

Risk Factors

The cause of AAA in some is not clear but there are some associated risk factors:

• Aged 65 years and older
• Gender– men are five times more likely than women to get AAA
• History of or currently smoking
• High blood pressure
• High cholesterol
• Family history – hereditary factors may increase risk
• Atherosclerosis (hardened arteries)
  

The U.S. Preventative Task Force recommends anyone aged 65 years who has ever smoked should get an ultrasound screening for abdominal aortic aneurysms, even if they have no symptoms.

Diagnosis

More than one million people in the US are estimated to have an undiagnosed AAA. If signs of AAA are detected, further testing may be required. If an aneurysm is detected on physical examination or ultrasound, further testing with a CT scan or MRI may be necessary to determine the aneurysm’s size and location in the body.

Treatment

The goal of treatment is to prevent aneurysm rupture. The two main treatments for AAA are medicines and surgery. Medicines can lower blood pressure and reduce the risk of the aneurysm rupturing. Surgery can repair or replace the injured section of the aorta.

There are two types of surgical treatments:

• Open Surgical Repair - an incision is made, the aneurysm is removed and the section of the aorta is replaced with a graft
• Endovascular Surgical Repair – the aneurysm is not removed. Instead, a stent is inserted into the aorta to strengthen it through a small needle puncture in the groin (Femoral Artery) 

Open Surgical Repair

• Isolating the aorta via laparotomy
• Aneurysm opened, graft sewn in, aorta wrapped and closed around the graft
  

Endovascular Aneurysm Repair (EVAR)

• Two punctures are made one in each groin to access femoral arteries to insert the device
• Stent is delivered, positioned, and deployed via a catheter
• Associated with shorter hospital stays and quicker recovery