What is an Aortic Aneurysm?
As the largest artery, the aorta has the responsibility of distributing oxygenated blood to all parts of your body. The aorta extends from the heart through the chest, down through the abdomen, and into the pelvic area. From there, the aorta divides into two major vessels that supply the lower trunk and both legs. Aortic aneurysms — the most common of which is an abdominal aortic aneurysm (AAA) — occur when part of the aorta weakens and expands like a balloon. This expansion can burst, causing massive internal bleeding. An AAA is defined as 1.5 times the size of the native aorta. Sometimes people with AAAs experience back pain or abdominal pain but there are usually no symptoms. An AAA is usually found on an imaging test such as an ultrasound, CT, or MRI done for other reasons.
AAA’s are more common in people over the age of 60 and are more common in men than women. There is a strong association with smoking. Other risk factors include a family history of AAAs, atherosclerosis, high blood pressure, and aneurysms in other parts of the body such as behind the knees (popliteal aneurysm). It is recommended that people over the age of 60 with a family history of AAAs or men between the ages of 65-75 who have ever smoked should have an ultrasound of the abdomen to look for an AAA.
How Can We Help?
Once an abdominal aortic aneurysms (AAA) is found, it needs to be monitored by an ultrasound of the abdomen or by a CT scan. However, not everyone who has an AAA needs surgery. This is because the risk of preventing a ruptured AAA needs to outweigh the risks associated with surgery. In general, surgery is recommended for men who have aneurysms greater than 5.5 cm, women who have aneurysms greater than 5 cm, or aneurysms that are growing in a short amount of time (more than 0.5 cm in 6 months). The mortality rate from surgery is between 1-5%. In the case of a ruptured AAA, mortality is closer to 50%. Patients who survive a ruptured AAA have a higher chance of post-operative complications.
Open surgery involves removing the section of aorta that is dilated and sewing in a piece of material called a graft. Graft failure is uncommon. Surgery usually takes 4 hours. After surgery, the patient will be admitted to the intensive care unit. Patients usually stay in the hospital 5-7 days and resume usual activities in 4 weeks.
Endovascular stenting is not as invasive as open surgery but only certain patients have the proper anatomy to accommodate the graft. An incision will be made in the groin and special catheters, balloons and grafts are placed in the area of the aneurysm. Patients are still admitted to the intensive care unit for monitoring but often go home in 2 days. Patients are able to resume usual activities much sooner than if they had open surgery. Endovascular stenting requires a yearly CT scan to make sure the graft remains in place.
Who to Contact
Dr. Charlie Jones and Dr. Susan Hagen are general, vascular and thoracic surgeons with over 30 years of experience. To make an appointment, please call 303-443-2123.