What is an Abdominal Aortic Aneurysm?
An abdominal aortic aneurysm is an enlargement of the lower part of the aorta that extends through the abdominal area (at times, the upper portion of the aorta in the chest can be enlarged). The aorta is the main blood vessel that carries blood from the heart to the rest of the body. Like most arteries, the aorta is elastic, which allows it to be filled with blood under high pressure. An aneurysm develops when the wall of the artery becomes weakened and distended like a balloon. The analogy of a bubble in a garden hose would be appropriate in describing an aneurysm. Aneurysms usually are discovered before they produce symptoms, such as back pain, but like the weakened hose, they may rupture if they become too large. Since a ruptured aneurysm is extremely dangerous and can cause life-threatening bleeding, aneurysms are best corrected by an operation before this happens.
Aneurysm of the abdominal aorta: What are some Predisposing Factors for Abdominal Aneurysms?
Who should be screened for Abdominal Aortic Aneurysm?
An abdominal aortic aneurysm (AAA) is a major health risk that may not have related symptoms until a life-threatening event occurs, such as aneurysm rupture. An abdominal ultrasound is a preventive screening tool that can be used to identify an AAA so that prompt treatment can be provided prior to aneurysm rupture.
Medicare Screening Guidelines
Currently, Medicare is offering a one-time, free abdominal ultrasound AAA screening to qualified senior citizens as part of its Welcome to Medicare physical. This physical must be conducted within the first 12 months of enrollment in Medicare. Men who have smoked at least 100 cigarettes during their lifetime, and men and women with a family history of AAA qualify for the Medicare screening. Abdominal aortic aneurysm (also known as AAA, pronounced "triple-a") is a localized dilatation or ballooning of the abdominal aorta (the main artery in the body) exceeding the normal diameter by more than 50 percent. Approximately 90 percent of abdominal aortic aneurysms occur below the renal (kidney) arteries, but they can also occur at the level of the renal arteries or above the level of the renal arteries. Such aneurysms can extend to include one or both of the iliac arteries in the pelvis as well.
Abdominal aortic aneurysms are sometimes palpable on physical exam and occur most commonly in individuals between 65 and 75 years old and are more common among men and smokers. They tend to cause no symptoms, although occasionally they cause pain in the abdomen and back (due to pressure on surrounding tissues) or in the legs (due to disturbed blood flow). The major complication of abdominal aortic aneurysms is rupture, which is life-threatening, as large amounts of blood spill into the abdominal cavity, and can lead to death within minutes. Mortality of rupture repair in the hospital is greater than 50%
Treatment for Abdominal Aortic Aneurysm
Treatment for infrarenal abdominal aortic aneurysms can be performed via two methods which differ greatly in their intra-operative as well as post-operative care. EVAR (EndoVascular Aneurysm Repair) is a procedure through very small incisions in the groin where a graft is inserted into an artery and guided into the aneurysm and excluding flow from the dilated vessel wall. EVAR has a shorter recovery allowing a quicker return to normal activities, is less painful and is overall a newer procedure being performed since the late 1990's. Closer follow up is required with CT scans and/or ultrasounds. Normally the hospital stay is between 1-3 days for this procedure. Open repair requires a large incision in the abdominal midline. The intestines are swept to the side and the aortic aneurysm is surgically opened and a graft is sewn as an interpositional graft. This surgery has been performed for many years and has an excellent long-term follow up with minimal follow-up imaging required. Because of the larger incision, the hospital stay can average from 7-10 days with a higher chance of complications such as peri-operative ileus, pain, heart attack, and even death. Patients should plan to take 4-6 weeks off from work or more. There are large differences between these methods and a discussion should be held with your vascular surgeon regarding which repair is indicated for you.