What is an Abdominal Aortic Aneurysm (AAA)?

An aortic aneurysm is the dilation, bulging, or ballooning out of part of the wall of the aorta, the artery through which blood flows out of the heart to the body. Abdominal aortic aneurysm refers to the section of the aorta within the abdominal region that eventually splits off into two smaller iliac arteries that supply blood to the pelvis and legs.  An aneurysm develops where the wall of the aorta has weakened, often due to atherosclerosis, high blood pressure, genetic defects, or other causes. It is considered to be an aneurysm when the widening of the area is more than 1.5 times its normal size.

When does a patient’s condition require AAA repair?

The pressure of blood flow within the aorta may eventually lead to the aneurysm expanding and rupturing. Ruptures are very painful events that cause massive internal bleeding, and usually death.  There is low risk of rupture if the abdominal aneurysm is less than 4 centimeters. However, an increase in the size of an aneurysm means an increased risk of rupture because the wall stress is proportional to the diameter of the vessel.

What tests can determine a need for AAA repair?

An ultrasound examination of the abdomen is a noninvasive test that uses sound waves to visualize the aorta and any aneurysm that may be present.

A CAT scan (computed axial tomography scan) is a highly accurate test for assessing aortic aneurysms. It is performed with a contrast medium (or dye) to create two- dimensional sectional pictures in 0.5 cm cuts (sections) of the abdomen.

A magnetic resonance imaging (MRI) test may assess aortic aneurysms through high resolution contrast imaging of the arteries and blood flow, and can provide a three-dimensional picture of the aorta.

An aortogram is an invasive catheter based procedure for assessing the extent of disease in the arteries of the lower extremities as well as pre-surgical evaluation of aortic aneurysms.

How is AAA repair performed using a stent?

During abdominal aortic aneurysm stent graft repair, a device called a stent-graft is inserted into the aorta from one of the arteries in the groin under local anesthesia. In a stent-graft procedure (also known as endoluminal aortic stent grafting or endovascular repair), the physician places the device into the aorta at the level of the aneurysm, creating a new channel for blood to flow, without coming into contact with the walls of the aneurysm, so there is no stress on the walls of the aneurysm any longer. Because the grafts are delivered via a catheter, the use of grafts is much less invasive than traditional surgery. The recovery time is greatly reduced and the amount of pain and risk of other complications are much less also.  Aortic aneurysm stent graft repair procedure and the devices used in this procedure under go frequent improvements and the results achieved are correspondingly better with each advance in technique and technology.

What should be expected after AAA repair?

Proper wound care in the groin area post-procedure is essential to avoid such complications as infection and bleeding. Vigorous physical activities and heavy lifting should be avoided for two weeks afterthe procedure. Mild discomfort, bluish discoloration and swelling in the groin area are common. A low grade fever (101 degrees F, maximum) is a common occurrence for up to a week following the procedure. Contact your physician if high fever or chills, bleeding, an increase in swelling or hematoma, or an increase in groin or leg pain should occur.

To assure good long-term results after the procedure you should be seen by your physician at the following intervals:

• One week
• One month
• Six months
• Annually thereafter

The usual recommendation for AAA repair follow up is a CT scan without and with contrast and 3 mm cuts or MRA of the abdomen and pelvis at the following intervals:

• One month
• Six months
• Annually thereafter