Abdominal Aortic Aneurysms

OVERVIEW

Each year approximately 200,000 new cases of abdominal aortic aneurysms are diagnosed. Also known as AAA, an abdominal aortic aneurysm is a bulge in the aorta which could rupture with life-threatening results.

An abdominal aortic aneurysm is the swelling or ballooning of the abdominal aorta. The aorta is the main artery that carries oxygen-filled blood from the heart to all parts of the body. In the abdomen, the aorta splits (bifurcates) into the iliac arteries, which carry blood to the legs and other lower areas of the body.

An aneurysm is a ballooning of the aorta which results from a weakened section in the artery that cannot support the force of blood flow. Although an aneurysm can occur in any artery of the body, it is most common in the abdominal aorta and the iliac arteries. While the aorta’ diameter normally ranges from ¾-inch to 1-inch, an aneurysm can cause it to grown to several times its normal size. This condition, if not treaded, could result in a rupture (bursting) of the aorta. The risk of rupture increases with aneurysm size and high blood pressure. Ruptured aneurysms are frequently fatal and are a leading cause of death in the US.

An angiogram or additional testing such as CT Scan, MRI (Magnetic Resonance Imaging), or IVUS (Intravascular Ultrasound) to determine the precise location, size and shape of the aneurysm and your surrounding arteries may be needed.

The Screening Abdominal Aortic Aneurysms Very Efficiently (SAAAVE) Act, which implements aortic aneurysm screening as a Medicare benefit, was signed into law in 2006. Effective January 1, 2007, Medicare provides a free, one-time ultrasound screening to check for AAA. Men (ages 65 to 75) who have smoked sometime during their lifetime, and men and women (ages 65 to 75) with a family history of AAA are now eligible for this screening within six months of enrolling on the Medicare system. Additional information about this benefit is available from the Society for Vascular Surgery SVS) website at: www.VascularWeb.org/medicarescreening.



TREATMENT

The size and location of the abdominal aortic aneurysm, and your general health, will determine how your aneurysm should be treated. When the aneurysm is small, your doctor may only recommend periodic check-ups to monitor the aneurysm. However, a larger or rapidly growing (expanding) aneurysm poses more risk of bursting (rupture), and as such, may require treatment.

Two procedural options are available if your doctor feels treatment sis necessary; open surgical repair or endovascular repair.

Open surgical repair has been the traditional choice to treat abdominal aortic aneurysms. During this type of operation, the doctor makes an incision (cut) in the abdomen or side of the patient and repairs the aorta by replacing the diseased section (aneurysm) with a synthetic graft (tube) that is sewn into place with suture. This procedure requires stopping the flow of blood through the aorta while the graft is being put into place. Open surgical repair is typically performed under general anesthesia and takes about 2 to 4 hours to complete. Patients usually stay overnight in the intensive care unit and another 5 to 7 days in the hospital. Depending on how quickly your body heals, hospitalization and recovery time may take about 3 months.

Endovascular repair is a relatively new procedure for the treatment of abdominal aortic aneurysms. Less invasive then open surgery, it involves excluding (sealing off) the aneurysm by placing an endovascular graft inside of the diseased aorta, making a new path for the blood to flow. The endovascular graft remains inside the aorta permanently through the use of metal prongs, or anchors as well as a tight fit (radical force) against the wall of the aorta, Endovascular repair may be performed under general, regional or local anesthesia while the patient remains conscious (awake) but sedated, and typically takes 1 to 3 hours to complete. Patients may have a hospital stay of only a few days and can usually return to normal activity within 6 weeks after the procedure.

Physicians at Texas Surgical Associates in the Bay Area have successfully treated over 100 AAA patients using a minimally invasive endovascular approach. At five years, pivotal trial investigative site data involving 235 patients treated with this endovascular approach have demonstrated zero ruptures, zero graft tears, one post-procedure migration, one stent fracture, 10% endoleak rate (0% Type 1, 8% Type II, 0% Type III and IV and 2% indeterminate), a low post-procedure conversion rate of 4.3%, and 100% cumulative patency.