The aorta is the main blood vessel coming out of the heart. It has multiple branches through which supplies oxygenated blood to all the parts of the body. An abdominal aortic aneurysm (AAA) is a swelling of the aorta, in the abdominal part, which develops over many years. Commonly accepted definition of abdominal aortic aneurysm is the diameter of the aorta being greater than 3cm. Normal abdominal aorta is less than 2cm. Aneurysms can also be found in other arteries.
The main causes of AAA are smoking, high blood pressure, family predisposition and age. AAAs are usually asymptomatic and are found incidentally with scans for other conditions.
AAA are of concern, when the diameter is over 6cm. Above this size there is definite risk of rupture (bursting). This is often fatal. Luckily, if the aneurysm is detected early, regular scans to monitor it, and repair can be safely performed.
There are two ways to approach repair of the aorta. They are described as endovascular (EVAR) or stent repair verses open repair.
Endovascular repair (EVAR) is usually performed with small holes in both groins. The stent graft is deployed using x-rays and forms a sleave inside your aorta to strengthen it. This is the preferred method, though it is not possible in all patients. This is mainly due to size, angles and touristy of the aorta. Patients are in hospital for one to two days and a short recovery at home. The procedure has a 1% to 2% risk of dying. As the stent is not sewn in place, patients will require ongoing scans to monitor the repair for the rest of their lives. Some patients may need additional stents placed in the future.
Open repair involves a large cut in the abdomen with replacement of the diseased artery with a synthetic tube sewn in place permanently with stitches. This operation has been performed for 60 years and is very effective and durable. You would expect to be in hospital for 5-10 days with further several months recovery required at home. This is a major operation and has about a 5% risk of dying associated with it.
There are many things to discuss and consider when the diagnosis of AAA is made. Dr Giri Mahadevan, will be able to explain and counsel you regarding the best option for you.