When the wall of a blood vessel weakens, a balloon-like dilation called an aneurysm sometimes develops. This happens most often in the abdominal aorta, an essential blood vessel that supplies blood to your legs.
Aortic aneurysm is common, especially in the western world. In India, it is often not diagnosed until too late.
Every year, 200,000 people in the U.S. are diagnosed with an abdominal aortic aneurysm (AAA).
A ruptured AAA is the 15th leading cause of death in the country, and the 10th leading cause of death in men older than 55.
Family history is important
Aneurysms run in families. If a first-degree relative has had an AAA, you are 12 times more likely to develop an abdominal aortic aneurysm. Of patients in treatment to repair an AAA, 15–25% have a first- degree relative with the same type of aneurysm.
Symptoms USUALLY HIDE
In most cases, abdominal aortic aneurysms cause no symptoms and are found when you are being evaluated for another medical condition.
SUDDEN, SEVERE ABDOMINAL OR BACK PAIN
If you have a family history of AAA and feel sudden, severe pain in your abdomen or back, seek immediate care. These symptoms may signal that you have developed an AAA, possibly one in process of rupturing.
PAIN, DISCOLORED SKIN, SORES ON FEET AND TOES
A small percentage of patients with AAA have these symptoms when plaque or blood clots from elsewhere in the body collect in the feet and toes.
Many factors contribute to AAA formation.
Some type of inflammation that causes a weakening of the wall of the aortic artery.
Men older than 60, smokers, Caucasians and anyone with a first-generation relative who has developed an AAA are at highest risk for an abdominal aortic aneurysm.
Age (50+ for men, 60+ for women) and a history of atherosclerosis , high blood pressure, elevated cholesterol, heart or peripheral vascular disease and tobacco use are all associated with AAA formation.
Other potential factors associated with AAA formation include tears in the arterial wall, infections, and congenital connective tissue disorders.
Most AAAs cause no symptoms and are found incidentally, during an evaluation for another medical condition. If you are affected, see a vascular surgeon.
Imaging tests may be needed
An abdominal ultrasound is painless, cost-effective, safe and the most frequently utilized test to screen for and measure the size of an AAA.
Computed tomographic angiography (CTA) will assess aneurysm size, location and the extent of impact. This study requires exposure to radiation and injection of an intravenous contrast agent. However, a CTA provides valuable anatomic information and can help your vascular surgeon determine the optimal type of repair.
Treatment depends on the size of the aneurysm.
Small AAAs (less than 5 cm in diameter)
Have a very low risk of rupturing, but should be watched.
It’s important to have regular ultrasound tests to monitor for aneurysm growth and risk of rupture. Lifestyle changes that help control blood pressure and medication may help you. Stop smoking. Daily exercise is also beneficial.
Larger (more than 5.0–5.5 cm in diameter)
Rapidly enlarging and AAAs causing symptoms are usually repaired. Repair can be done through small cuts in your leg using stents (EVAR) or by open surgery. Whether your aneurysm is suitable for stent or open surgery will be decided after careful review of the CT scan and an assessment of your health and discussion with you.
EVAR: Endovascular aneurysm repair?
Endovascular aneurysm repair is a minimally invasive state of art technology, which involves inserting a special stent graft within the aneurysm through small thigh incisions. The procedure is done under X Ray guidance for accurate placement of the stents.
Not every patient or every aneurysm is suitable for EVAR. In particular, aneurysms arising close to or above the kidneys require more complex stents grafts. You will be assessed with a CT-Scan to determine if your aneurysm can be treated by endovascular repair. If suitable you will be offered a choice of type of repair by your surgeon.
The advantage of this type of repair is that there is no abdominal surgery. The procedure can even be done with you awake.
For those with kidney problems it is possible to undergo this treatment using specialized methods available with your doctors.
This technique results in a rapid recovery and shorter hospital stay than with open surgery.
The aneurysm is approached through a cut on your tummy. The weakened area of the blood vessel is replaced by a plastic tube (graft) that is sewn into place.
The surgery will take 3-5 hours to complete and you will typically spend a few days in ICU after surgery.
Open surgery is very successful but is associated with a longer initial recovery period.
The risk of a major complication is lower for endovascular repair, as the operation does not interfere with the circulation as much as open surgery. However, the graft may develop endoleak. As a result, you may need follow up with scans to ensure that the graft is secure in the Aorta.
After uncomplicated endovascular repair, most patients return to the hospital ward for one to three days. You should be able to eat and drink normally once fully awake following your aneurysm repair. The nurses will aim to getting you sitting up and walking as soon as possible. Once you are up and about, you should be able to leave hospital, but may need painkilling tablets for up to a week.
Is surgery successful?
If aneurysms are successfully repaired, this prevents them blocking or bursting and there is a very high likelihood that you will return to a normal life. Full recovery takes between 3 and 6 months after open surgery and 2 weeks after endovascular repair. The speed of recovery will also be affected by your age and general fitness.
What are the risks of Open surgery?
As with any major operation general complications can occur including infection in the wound, chest infections or diarrhea.
There is a small risk of you having a medical complication such as:
Loss of circulation in the legs or bowel
Infection in the graft used to replace your aorta