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Abdominal Aortic Aneurysm

Surgical Aneurysm Repair
Endovascular Stent Graft

What is abdominal aortic aneurysm?

The aorta is the largest artery in your body, and it carries blood from your heart out to the rest of the body. Your aorta starts in your chest, where it is called the thoracic aorta. When it reaches your abdomen, it is called the abdominal aorta. The abdominal aorta supplies blood to the intestines, liver and kidneys. Just below the abdomen, the aorta splits into the iliac arteries which carry blood to each leg.

When a weak area of the abdominal aorta grows, it is called an abdominal aortic aneurysm (AAA). Normally, the aorta is about 2.5 cm in diameter. An aneurysmal aorta can grow to 5 cm or beyond. Aneurysms this large are a health risk because of the chance of rupture. This can cause massive internal bleeding and can be fatal.

Abdominal aortic aneurysm is a common condition throughout Charlottesville and Central Virginia. Each year, physicians diagnose approximately 200,000 people in the United States with AAA. Of those 200,000, nearly 15,000 may have AAA threatening enough to cause death from a ruptured aneurysm if not treated. Fortunately, when diagnosed early, AAA can be treated, or even cured, with highly effective and safe treatments.

What are the symptoms?

Many people do not feel any symptoms with an abdominal aortic aneurysm. Occasionally, patients can experience:
  • A pulsing feeling in the abdomen, similar to a heartbeat.
  • Severe, sudden pain in your abdomen or lower back. If this is the case, your aneurysm may be about to rupture.

If your aneurysm ruptures, you may suddenly feel intense weakness, dizziness, or back pain, and you may lose consciousness. This is a life- threatening situation and you should seek medical attention immediately.

What causes an abdominal aortic aneurysm?

The etiology of an aneurysm is probably multi-factorial. The leading thought is that the aneurysm may be caused by inflammation in the aorta, which may cause its wall to break down. Some researches believe that this inflammation can be associated with atherosclerosis (also called hardening of the arteries) and risk factors that contribute to atherosclerosis, such as high blood pressure (hypertension).

Besides atherosclerosis, other factors that can increase your risk of abdominal aortic aneurysm include:

  • Being a man older than 60 years
  • Having an immediate relative, such as a mother or brother, who has had abdominal aortic aneurysm
  • Having high blood pressure
  • Smoking

Your risk of developing abdominal aortic aneurysm increases as you age. AAA is more common in men than in women.

How is an aneurysm diagnosed?

Abdominal aortic aneurysms are most often found when a physician is performing an imaging test for another condition. If your physician suspects that you may have AAA, he may recommend one of the following tests:
  • Abdominal ultrasound
  • Computed tomography (CT) scan
  • Magnetic resonance imaging (MRI)

How is an abdominal aortic aneurysm treated?

Watchful waiting
Your physician may recommend "watchful waiting," which means that you will be monitored every 6 months for signs of changes in the aneurysm. Your physician may schedule you for regular CT scans or ultrasounds to watch the aneurysm. This method is usually used for aneurysms that are smaller than 5 centimeters or 2 inches. If you also have high blood pressure, your physician may prescribe blood pressure medication to lower your blood pressure and lower the pressure on the weakened area of the aneurysm.

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surgical aneurysm repair
A vascular surgeon may recommend that you have a surgical procedure called open aneurysm repair if your aneurysm is causing symptoms or is larger than 2 inches, or is enlarging under observation.

During an open aneurysm repair, also known as surgical aneurysm repair, your surgeon makes an incision in your abdomen and replaces the weakened part of your aorta with a tube-like graft. This graft is made of man- made material, such as woven fabric, in the size and shape of the healthy aorta. This tube replaces the diseased portion of your aorta and allows blood to pass easily through. Following the surgery, you may stay in the hospital for 5 to 7 days. You will have 2 to 3 months for a complete recovery. More than 90 percent of open aneurysm repairs are successful for the long term.

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Endovascular stent graft
Instead of open aneurysm repair, your vascular surgeon may consider a newer procedure called an endovascular stent graft (See Endovascular Aneurysm Repair). Endovascular treatment involves passing wire and catheters through the arteries with the aid of x-rays. This procedure is less invasive, meaning that your surgeon will make only small incisions in your groin area through which to thread the catheters.

During the procedure, your surgeon will use live x-ray pictures on a video screen to guide the aortic graft, or replacement, to the site of aneurysm. This graft is opened inside the aorta and creates a new lining and pathway for blood to flow. The outside aneurysm is excluded from blood flowing through the graft. The recovery time for endovascular stent graft is much shorter than open surgery, and the hospital stay is reduced to 2 or 3 days. This procedure is more likely to require periodic maintenance than the open procedure. In addition, you may not be suitable to have this procedure, since not all patients are candidates for endovascular repair. In some cases, open aneurysm repair may be the best way to cure AAA.

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