Aortic Aneurysms - AAA

• What is an aneurysm?
    
• Who is at risk for aneurysms?
    
• What causes an aneurysm?
    
• How do I know if I have an aneurysm?
    
• What do I do if I have an aneurysm?
    
• What does a vascular surgeon do?

This angiogram picture shows a typical aortic aneurysm. As the aneurysm gets larger, the risk of rupture increases greatly.

Aneurysms occur most often in the aorta, the main artery of the chest and abdomen. The aorta carries blood flow from the heart to all the vital organs and eventually to the legs and feet. Abdominal aortic aneurysms (AAA) are caused by a progressive weakening of the aortic wall that causes a dilation, or “ballooning” of the vessel. The aneurysm will grow larger and eventually rupture if it is not diagnosed and treated.

When an aortic aneurysm ruptures it is an emergency!

• Many people don't even make it to the hospital, and those who do often die of complications.
  
  
• Ruptured aortic aneurysm is the 13th leading cause of death in the US.
  
  
• More than 15,000 Americans die each year due to ruptured aneurysms, many of them needlessly!

That's why we say, "It's a matter of life and limb!"

When aortic aneurysms are diagnosed early, treatment is safe and effective and the aneurysm is cured! AAA can be diagnosed by a simple ultrasound scan that can be performed in a few minutes without risk or discomfort.

Surgery is usually required to repair an AAA, but modern, catheter-based technologies using endovascular grafts have made treatment less invasive in many cases. The combination of early diagnosis and modern treatment of aortic aneurysms can save countless lives lost due to aneurysm rupture each year.

Major risk factors for abdominal aortic aneurysms

• Age over 60 years
• A family history of AAA
• Smoking
• High blood pressure

The risk of AAA increase with age and aneurysm are much more common in men than in women. A family history of AAA is particularly concerning, so if any of your relatives had an aneurysm, tell your doctor arrange a screening exam!

Cause of Aortic Aneurysms
Most aneurysms are caused by a breakdown in the proteins that provide the structural strength to the wall of the aorta, the body's main artery. These proteins, called collagen and elastin can gradually deteriorate with age, but inflammation that is associated with atherosclerosis can accelerate this process even in younger people. There are also naturally occurring enzymes that cause the breakdown of collagen and elastin. An excess of these enzymes or other conditions that activate these enzymes may also contribute to the formation of an aneurysm, or its sudden growth. In rare cases an aneurysm may be caused by infection. There is still much to be learned about the cause of aneurysms and their growth, but fortunately we have successful, permanent treatments for AAA when they occur. Vascular surgeons have performed much of the basic research on aneurysm formation.

This CAT scan picture shows a very large aortic aneurysm.

Diagnosis of AAA
Although AAA can be detected by physical examination, most are diagnosed today using an ultrasound scan or CAT scan, simple exams that are non-invasive and can be done as an outpatient. These exams also tell us how big the AAA is – the key element to determine the need for treatment!Most patients have no symptoms at the time an AAA is discovered. Aneurysms are often detected on tests that were performed for entirely different reasons. Since major surgery was required in the past to repair an aortic aneurysm, that decision depended upon a comparison of the risk of rupture with risk of the surgery itself. Most doctors agree that for someone in good health, an AAA larger than 5 centimeters in diameter (about the size of a lemon) needs treatment. Smaller aneurysms may also need treatment if they cause symptoms (like back pain or abdominal pain), or tests show that the aneurysm has rapidly grown larger.

Treatment of Aortic Aneurysms
Surgical treatment of AAA has been performed for almost 50 years and is a successful and durable procedure. In surgery the diseased part of the aorta is replaced with a Dacron or Teflon graft that is carefully matched to the normal aorta and is sewn in place by the surgeon. While ultimately curative, this operation requires a major abdominal incision and general anesthesia, and the hospital stay averages 7-10 days for most patients. Even after uncomplicated surgery, it is often a month or two before patients can return to a full and normal life. Nevertheless, more than 90% of patients make a full recovery from surgery. After more than half a century of experience with these procedures we know that once patients have recovered, their aneurysms are permanently cured!

With the new endograft repair of AAA, x-ray guidance allows the surgeon to avoid a large incision.

Less Invasive Treatments of AAA – Recent advances in catheter-based technologies have led to exciting new treatments for aortic aneurysms. Now, endovascular grafting technology allows surgeons to repair the AAA by delivering a graft through a small incision in the groin, rather than the traditional major open surgery. The endovascular method, approved by the FDA in 1999, allows the graft to be delivered via a catheter (tube) inserted in a groin artery. In the operating room, x-ray guidance is used for proper positioning of the graft. The graft is then expanded inside the aorta and held in place with metallic hooks rather than sutures. The hospital stay is usually only one or two days, and most patients can return to work or normal daily activities in about a week. Even patients with serious medical problems, once thought to be too sick, or too frail to have surgery for AAA, may have their aneurysm repaired using an endovascular graft. This can avoid the need for major open surgery and also eliminate the risk of fatal rupture if the AAA was not treated at all. It’s very important for patients to know that endovascular grafting may not be possible in every case. Endovascular grafts are specially manufactured and don’t “fit” for every case. Also, in many cases, standard surgery is still the best since we don’t have 50 years of experience with these newer procedures like we do with surgery. There may still be serious problems we haven’t anticipated.

What does a vascular surgeon do?

Vascular surgeons have pioneered and refined the surgical treatment of aortic aneurysms, and made these treatments literally lifelong successes for their patients. When surgery is required for an aortic aneurysm, it is most safely and successfully performed by a board-certified Vascular Surgeon.

Vascular surgeons have pioneered and refined noninvasive tests, like vascular ultrasound, to detect problems like aortic aneurysms.

Vascular surgeons have pioneered and refined endograft treatment for aortic aneurysms.

The combination of earlier diagnosis with safer, simpler, and ever more successful treatments can prevent needless deaths due to ruptured abdominal aortic aneurysms. If you think you or one of your family members might have an aortic aneurysm, check with your family doctor. A simple ultrasound test can tell.

If you’d like to get the opinion of a Vascular Surgeon, click here to find a Vascular Surgeon near you.