What is an aortic aneurysm?
The aorta is the main artery of the body. It arises from the heart and runs through the chest and abdomen giving rise to branches that supply blood to the body. Aortic aneurysms occur when the wall of the aorta is weakened by disease and expands like a balloon. Over time the aneurysm continues to expand until the wall fails and the aneurysm ruptures. Ruptured abdominal aortic aneurysms are the 10th leading cause of death in men over the age of 50.
The diagnosis can be made on physical exam in many patients. The aneurysm is then more thoroughly evaluated using ultrasound or CT scanning. Many aneurysms are found on CT, ultrasound or MRI studies as an incidental finding. If the aneurysm does not meet criteria for repair then it is followed with CT or ultrasound at intervals of 6 months to 1 year.
What are the treatment options?
The traditional surgical repair of an abdominal aortic aneurysm is a major surgical procedure. A surgical incision is made in the abdomen and the damaged part of the aorta is replaced with a synthetic (Dacron) tube or graft. Recovery from the operation, which is performed under general anesthesia, typically requires 8 to 10 days. People who have other serious medical problems have increased risks for complications from the surgery. Over the last 10 years an alternative to this major surgery arose known as endovascular repair. In this procedure a device known as a stent-graft is inserted inside the aneurysm. This provides an internal bypass through the aneurysm taking the pressure off the wall and allowing blood to internally bypass the enlarged area.
What can I expect during this procedure?
A stent-graft is positioned across the aneurysm, with its ends seated into the normal diameter aorta above and below the aneurysm. This effectively isolates the aneurysm sac from the normal circulation and provides a new normal channel to provide blood flow to the lower abdomen, pelvis and legs. The stent-graft is delivered via specialized catheters, which are introduced through small surgical incisions in the groin. It is threaded through the abdominal aorta using x-ray guidance. The catheter is removed and the stent-graft expands into place. With this technique, there is no need to make a large incision in the abdomen or to cut away the damaged section of blood vessel.
What should I expect after this procedure?
Stent-graft placement can be done without general anesthesia. Many patients are discharged from the hospital the following day. Their overall recovery period before full activity is reached is usually around one week. The potential complications of major abdominal surgery are avoided. Surgical repair usually involves several days in the ICU with a hospital admission of around one week. To resume full activity after an open surgical repair can take months.