An aneurysm is an abnormal widening of a portion of an artery due to weakness in the wall of the blood vessel. Aneurysms occur most commonly in the aorta, the main artery of the chest and abdomen. The aorta is the body’s largest artery and carries blood flow from the heart to all vital organs and eventually to the legs and feet.
Abdominal Aortic Aneurysms (“AAA”) are caused by a progressive weakening of the aortic wall which results in a dilatation, or “ballooning” of the vessel. It will grow progressively larger and eventually rupture if it is not diagnosed and treated. Many patients do not survive long enough to make it to the hospital, and among those who do, more than half eventually die of complications. In fact, ruptured aortic aneurysms are the 13th leading cause of death in the U.S.
However when AAAs are diagnosed early, treatment is safe, effective and curative. While major surgery has been required to repair AAAs in the past newer, less invasive catheter-based techniques using endovascular grafting have now made treatment less complicated. The combination of effective diagnosis and the modern treatment can reduce the numbers of lives lost due to the condition.
Major risk factors for abdominal aortic aneurysms include those who smoke, have high blood pressure and are 60 or older. Also risk is increased if the patient has a family history of AAAs. Men are also more likely than women to suffer from the condition. The majority of patients have no symptoms at the time an AAA is discovered. In fact, AAAs are often detected on tests that were performed for entirely different reasons. Although an AAA can be detected by physical examination, most are diagnosed today using ultrasound scan or CAT scans, simple exams that are non-invasive and can be done as an outpatient. These exams can tell us whether an AAA is present and how big it is – the key elements to determine the need for treatment.
Surgical treatment of AAA has been performed routinely for almost 50 years and is a very successful 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 sewn in place by the surgeon. The operation is major surgery and requires an abdominal incision and general anesthesia. The hospital stay averages seven to-10 days for most patients and recovery time is about six to eight weeks before the patient can return to a full and normal life.
Recent advances in catheter-based technologies have led to groundbreaking treatments for aortic aneurysms. Now, endovascular grafting technology allows surgeons to repair the AAA by delivering a bypass graft through a small incision in the groin, rather than the traditional major open surgery. The endovascular method, approved by the FDA in the fall of 1999, allows the tightly wrapped graft to be delivered via a catheter (tube) inserted in a groin artery. In the operating room, using x-rays for proper positioning, the graft is secured in place by inflating a balloon to expand the graft to the size needed to prevent blood flow into the aneurysm. For most patients, the hospital stay is only overnight with a return to work or normal daily activities in about one week. Even patients with multiple medical problems, once thought “too sick to undergo traditional AAA repair,” can have their AAA repaired with an endovascular method, and often be home the next day.
Endovascular repair of AAA is being performed routinely at the Vascular Center at University of Maryland Baltimore Washington Medical Center. A select team of physicians including vascular surgeons and interventional radiologists provide a multidisciplinary approach to treatment and the special skills necessary to handle the most complex problems.
For more information about AAA repair or to contact one of our physicians, please call 410-553-8300.