Treatment of AAA
In early AAA stages, the immediate health risk is small. However, your doctor will want to see you on a regular basis to assure that your aneurysm is either not growing or growing very slowly. Rupture risk increases with aneurysm size, age, and other risk factors such as high blood pressure. When your aneurysm grows to an unacceptable size, your doctor will want to repair it before a critical situation develops. Most AAAs have a significantly higher chance of rupturing when they exceed 2 inches (5 cm) in size or if they expand rapidly. Much less commonly, an AAA can cause blood clots to pass into the legs, which can lead to additional complications. If an aneurysm ruptures, it can be very serious or fatal. Approximately 200,000 new aneurysms are diagnosed each year in the U.S. and are a leading cause of death.
What are the treatments for AAA?
Your general health and the size and location of your AAA will determine how your aneurysm is treated. Smaller aneurysms may be closely monitored by your doctor. If surgery is not required, your doctor may recommend an ultrasound or CT scan every 6-12 months to carefully monitor the aneurysm size and shape. Your doctor may also prescribe certain medications to help keep the aneurysm stable and, if you smoke, advise you to stop. If your doctor feels there is aneurysm rupture risk, surgical repair may be recommended. An AAA may be treated with either open surgical repair or by less invasive endovascular repair techniques.
Open Surgical Repair
Until recently, open surgical repair has been the most common procedure for AAAs. During this surgery, your doctor will make a cut in your abdomen or side, move your internal organs, and locate the portion of the aorta with the weakened wall. The affected area will be removed and the artery repaired with a fabric tube called a graft which is permanently sewn into place. The new graft acts as a replacement blood vessel.
The open surgical repair procedure typically lasts between 3-4 hours, requires general anesthesia, and blood flow in the aorta must be stopped while the graft is being inserted. Afterwards, an overnight stay in the hospital intensive care unit is usually required plus another 5-9 days in the hospital. Some patients are unable to eat normally for several days after surgery and overall recovery may take up to three months before normal activities may be resumed. Open repair is a proven medical procedure that works. However, not all patients can tolerate a major operation. As with any medical procedure, the possible risks should be discussed with your doctor.
Endovascular repair is a newer procedure for repairing AAAs. It is much less invasive than open surgical repair and involves placing a wire reinforced fabric tube graft (called a stent graft) inside your diseased aorta. The new stent graft is placed within the vessel and protects the AAA from blood pressure stress. Rather than making a large cut in your abdomen, your physician makes smaller cuts in your groin area. Through these cuts, they insert a Guide wire and then the stent graft pieces, which are contained in a small tube called a delivery system, are pushed through your femoral arteries and into the aneurysm by sliding along the guide wire. The stent graft is held in place through the use of metal hooks acting as anchors.
The endovascular repair procedure typically lasts between 1-3 hours and may be performed under general, regional, or local anaesthesia. Patients normally have a few days of hospital stay, may begin normal activities within a week, and can usually return to full physical activity within 4-6 weeks of the procedure. As a result, stent graft patients typically recover more quickly and experience less pain than those who have open surgery.
Not every patient is an endovascular repair candidate and there are possible complication risks. The risks and benefits of both the open surgical repair and endovascular repair procedures should be thoroughly discussed with your doctor.