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.
An 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 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 the highest risk for an abdominal aortic aneurysm. Age (50+ for men, 60+ for women) and 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 the 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. The 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 the 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 to 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 the hospital, but may need painkilling tablets for up to a week.
Is surgery successful?
If aneurysms are successfully repaired, this prevents them from 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 diarrhoea.
There is a small risk of you having a medical complication such as:
- Heart attack
- Kidney failure
- Chest problem
- Loss of circulation in the legs or bowel
- Infection in the graft used to replace your aorta
If your risk of a major complication is higher than this, usually because you already have a serious medical problem, your surgeon will discuss this with you. It is important to remember that your surgeon will only recommend treatment for your aneurysm if he or she believes that the risk of the aneurysm bursting is higher than the threat posed by the operation. Your surgeon will be able to tell you the success rate for this operation in his/her unit.
What can I do to help myself?
If you are a smoker the single most important thing you can do to help yourself is to give up smoking. Stopping smoking will also help to protect all of your arteries making it less likely that you will suffer from heart attacks or strokes.
Gentle exercise such as walking and cycling are recommended to help to improve your overall level of fitness. Exercise helps your body to produce healthy cholesterol and this helps to protect your arteries against bad cholesterol.
High blood pressure
High blood pressure is a known risk factor for the rupture of aneurysms. It is very important that you have your blood pressure checked regularly, at least every 6 months. If you have been prescribed medication for high blood pressure, you must make sure that you take it according to the instructions given.
If you have diabetes it is important that your blood sugar levels are well controlled.
High blood cholesterol levels
(fatty substance) in your blood. You should eat a healthy balanced diet and try to reduce any excess weight.