Abdominal Aortic Aneurysm - Endovascular Repair

This is the repair of a bulging, weakened area of the aorta through a small incision made in the groin.




This is the repair of a bulging, weakened area of the aorta through a small incision made in the groin.



An aneurysm is a bulging and weakening in the wall of an artery. The aorta is the main artery in your body. An abdominal aortic aneurysm (AAA) is an aneurysm found in the middle, or abdominal, section of the aorta.

  • An AAA is defined as a bulging of one and a half times the normal diameter of the aorta OR a diameter greater than or equal to three cm or 1.2 inches.
  • All aneurysms can enlarge over time. As they enlarge, there is a greater risk of the aneurysm bursting, which can cause massive bleeding and death.

There are two ways to repair an aortic aneurysm.

  • An endovascular repair is a newer surgical procedure that is done through a small incision made in the groin. A catheter (hollow tube) is inserted into a large artery in the groin and threaded up to the aorta. Using special x-rays, a collapsible tube (stent) is inserted into the aorta. The stent is expanded at the site of the aneurysm.
  • An open repair is a traditional surgery for repair of an AAA. This surgery is done through a large incision made in the abdomen, usually from top to bottom (vertical). A special graft (tube) is used to replace the weakened area of the aorta. This surgery has been done for many years. The need for additional surgery is rare.

Whether or not a person is suitable for an endovascular repair depends on:

  • The size and shape of the aneurysm
  • The condition of the arteries around the aneurysm

This care path includes the costs for an endovascular repair.

Your medical history can help determine if you have an increased risk for an AAA. A physical examination may not be reliable unless you have a pulsating abdominal mass that can be easily felt. It is particularly difficult to diagnose an AAA in a person who is overweight or obese. An AAA is often found on an imaging study (CT scan, x-ray or ultrasound) that was done for an AAA screening or other unrelated reasons. Risk factors for developing an AAA include:

  • Increased age
  • Sex (men have a much higher risk)
  • Family history
  • Personal history of aneurysms in other arteries
  • Smoking
  • High blood pressure
  • High cholesterol
  • Hardening of the arteries

The U.S. Preventive Services Task Force (USPSTF) recommends a one-time ultrasound screening for an abdominal aortic aneurysm (AAA) if you are a male between 65 to 75 years old and have ever smoked. According to the USPSTF, there is not enough evidence of medical benefit to screen asymptomatic:

  • Females
  • People who have never smoked
  • People younger than 65 years old

Early diagnosis and treatment of an AAA can decrease complications and increase the chance of survival. If you are diagnosed with an AAA, but have no symptoms, the decision on how and when to treat it is based on:

  • The size of the aneurysm
  • Your age
  • Your current health and medical history
  • Your risk for complications

Most people who have an AAA have no symptoms, so many are not discovered until they have ruptured, or burst open. Symptoms related to an AAA may indicate the aneurysm is enlarging or about to burst. These symptoms can include:

  • Abdominal or back pain that is constant and may be severe
  • A feeling of abdominal fullness
  • A pulsating abdominal mass

Signs and symptoms of an abdominal aneurysm that has burst open can include:

  • Sudden severe abdominal or back pain
  • Nausea and vomiting
  • Low blood pressure
  • Lightheadedness/dizziness or a faint feeling
  • Rapid pulse
  • Pale and clammy skin

This is a medical emergency, and requires immediate medical attention.

Aneurysms less than 5.5 cm may be watched closely to see if they are growing. The larger the aneurysm, the higher the risk the aneurysm will burst and the more frequent the monitoring.

  • There is no proven treatment to stop an aneurysm from growing. However, your healthcare provider may prescribe medications to lower your heart rate, blood pressure and cholesterol.
  • Tobacco products and secondhand smoke harm the heart, blood vessels, circulation and other parts of the body. Smokers will be encouraged to quit and avoid secondhand smoke.

If your healthcare provider recommends a repair of your AAA, prior to surgery tell him or her about any medications you are taking (including over-the-counter medications and supplements). Ask about specific instructions you should follow before surgery. These may include:

  • Medications you should not take before the surgery, such as blood thinners
  • Regular medications you should take on the day of your surgery
  • How many hours you should stop eating and drinking before surgery

If you are a smoker, you should quit smoking, as it can interfere with your recovery.

During your surgery, you will receive anesthesia to keep you comfortable and pain free.

  • General anesthesia is the most common type of anesthesia for an open AAA repair. With this type of anesthesia, you are put into a deep sleep and are unable to see, hear, or feel anything.
  • Either local, spinal or general anesthesia are possible for an endovascular AAA repair.

You will spend a few of days in the hospital after surgery. You may need pain medication and help at home while you recover.

If you have any symptoms of an abdominal aortic aneurysm, make an appointment with your healthcare provider to discuss your options. If you have symptoms of rupture of a AAA, as described above, you must seek medical attention immediately.

During an office visit for evaluation of a possible AAA, ask your healthcare provider the following questions.

  • Am I at risk for developing an aneurysm? How can I decrease my risk?
  • Do I have an aneurysm? How large is it and what are my treatment options?
  • Do I need any special tests? What are the benefits and risks of having the tests?
  • Will the tests change your treatment recommendations? If not, is there a need for them?
  • What are the benefits and risks of an endovascular repair versus an open repair?
  • Is one type of surgery a better option over the other for me? Why or why not?
  • What are the possible complications for each type of surgery?
  • How will I feel after the surgery and will I have to modify my activity?
  • What is your experience in doing this type of surgery? What is your complication rate?
  • What symptoms are normal after the procedure? When should I be concerned?
  • How long after surgery should I follow-up with you?

After your surgery, you should know what you had done, what medication was given, and what symptoms you should report to your healthcare provider after discharge. You should also understand all home care instructions (including medications and side effects) and follow-up plans. Your surgeon should also communicate with your primary care physician.

Source UHC.com

Also known as:

Rupture
Endovascular Repair
Bulging
Aortic Aneurysm
Aorta
Aneurysm
Abdominal Aortic Aneurysm
AAA


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