Aortic Aneurysms.

Abdominal Aortic Aneurysm (AAA)

Treatments

(AAA) is a condition of the main artery or blood vessel in the body as it passes the abdomen.  The aorta which is usually about 2cm in diameter dilates increasing in size due to a defect in the wall of the aorta called medial degeneration where the middle layer loses its strength and the overall strength in the wall reduces.  The overall effect here is that a portion of the aorta increased in diameter over time and this condition is genetic in nature.  Other problems like smoking and high blood pressure can make it worse.  The condition is silent being picked up often as a result of a scan done for other reasons.  In some countries populations are screened for it.  Unfortunately in some patients the aneurysm is not detected and the first indication it is there is when it ruptures or bursts.  On these occasions it is frequently fatal.  As a result the objective is to find and repair these aneurysms before they get to large and the risk of rupture becomes high.  Once they are detected they can grow very slowly and as a result they may not pose a significant risk to the patient.  However they must be followed and this is usually done by ultrasound.  When the aneurysm gets to about 5cm or a little bit bigger you start to have an increased risk of rupture and repair should be considered.  At this point a more detailed scan - normally a CT scan, is performed to look at the exact configuration of the aneurysm.

There are two main options for repair.  The traditional open repair where the abdomen is opened, the aorta is isolated and clamped off and a new lining is sewn into place.  While this operation has stood the test of time and produces excellent results it is a big procedure and has a significant recovery time.  Over the last 20 years a more minimally invasive alternative has developed - endovascular aneurysm repair (EVAR).  The aorta is relined via exposure and access through the femoral arteries at both groins.  The procedure involves assembling 2 or more stents covered in fabric in the aneurysm to produce a new lining. This is done using x-ray guidance. The recovery is faster and the operation is often better tolerated.  The problem is that the operation although seemingly very durable necessitates lifelong follow up scans and may result in other add-on procedures in the future.  In addition the initial CT scan may show the aortic configuration to be such that EVAR is a more challenging option.  As a result open surgery maybe the best option. This means each patient needs to discuss their particular situation with the surgeon to come up with the most suitable plan for them. This is particularly the situation for more complex cases.  For patients who have just had an aortic aneurysm detected they need to moderate their risk factor such as control of blood pressure and stop smoking.  First degree relatives should be advised to have a aneurysm detection scan given the inherited nature of the condition.  This should normally be done from the age of 55 years and beyond.

 

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