The aorta is the largest blood vessel in the body, originating from the heart, supplying oxygen rich blood to organs in your chest and abdomen, and dividing into the iliac arteries supplying blood to your legs. An abdominal aortic aneurysm is a dilatation of the aorta greater than one and a half times its normal size, due to weakening of the wall. The most common location is below your kidney arteries, although it may involve the kidney arteries or extend above them, involving the arteries supplying blood to the intestines, liver, stomach and spleen.
About 1.7 million people have AAAs in the United States and 190,000 new cases are diagnosed annually. The incidence has tripled since 1970, and about 50,000 repairs are performed annually.
An abdominal aortic aneurysm occurs from weakening of the wall. Genetics, cholesterol and fatty buildup (plaque), smoking, high blood pressure and inflammation can lead to weakening of the wall and aneurysm formation. An abdominal aortic aneurysm may be lethal because as it enlarges, it may rupture. Most AAAs have a significantly higher chance of rupturing when they exceed 5 cm in size, or if they grow rapidly (greater than 0.5 cm/yr). When they rupture, bleeding occurs and usually leads to death.
To determine if you have an AAA, your medical doctor on routine history may ask you if you have had a family member with an aneurysm, or a history of flank, back, or abdominal pain, or blue toes. Also, on routine physical examination, your doctor may identify a pulsatile abdominal mass. If an AAA is suspected, a non-invasive ultrasound can detect an aneurysm and a CT scan can determine its size.
Abdominal aortic aneurysms should be repaired when they exceeds 5 cm in size, grow more than 0.5 cm/ year, are causing back, side or abdominal pain, or are showering clots to the legs causing blue toes, or if rupture occurs. There are two ways to repair a AAA, by open surgery, or minimally invasive, endovascular surgery.
Open surgery consists of an incision in the side or down the middle of the abdomen, with possible incisions in the groins. In simple terms, organs are moved to access the aorta, it is clamped above and below the aneurysm, the aneurysm is opened, and clot is removed. A synthetic graft is sewn to normal aorta above and below the aneurysm, and the wall of the aorta is wrapped around the graft. Circulation is then restored, and the abdomen is closed.
Endovascular repair can be performed under local, spinal, or general anesthesia. Either small incisions, or needle punctures are made in the groins. Needles, wires, sheaths and catheters are directed into the aorta, and under X-ray guidance, measurements are made and a stent-graft is deployed inside the aneurysm, excluding it from circulation. The stent graft is held in place by stents, hooks, or pins against the wall of the aorta. A completion picture is taken to make sure no leak is present, and the groins or puncture sites are closed.
Patients with abdominal aortic aneurysms should consult with their physician about the risks and benefits to the types of surgery in order to make the most appropriate decision for their individual needs.
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