Abdominal Aortic Aneurysm Repair
Things You Should Know

Abdominal aortic aneurysm repair is undertaken either as a major open abdominal surgery or as a "minimally invasive" keyhole surgery in which a graft is railroaded into the ballooned part of the aorta through a small, pinhead-sized cut in the groin.

Men over the age of 60 are at greater risk of developing an abdominal aortic aneurysm.

What is an Abdominal Aortic Aneurysm?

An abdominal aortic aneurysm is the enlargement, or swelling, of the aorta, the main blood vessel running from the heart that delivers blood to the abdomen, pelvis, and legs.

When the aorta widens as it runs through the abdomen, the condition can become life threatening if left untreated. An Abdominal aortic aneurysm is a serious medical condition that affects 5 to 7% of people over the age of 60. Men are four times more likely to develop this disease than women. About 15,000 people die of the disease annually, as ruptured aneurysms that happen outside the hospital are fatal 90% of the time. The good news is that with adequate planning, most aneurysms can be surgically repaired with great success. 

Should You Repair an Abdominal Aortic Aneurysm?

Before diving into the specifics of whether to repair and abnormal aortic aneurysm, first determine what is normal, what is abnormal, and when this disease can be life-threatening.

A normal-sized aorta has a diameter of anywhere from 1.5cm to 2.5cm. When any part of the aorta widens more than 2.5cm due to swelling, inflammation, or dilation, it is usually diagnosed as an aneurysm. A small aortic aneurysm has diameter of 3 - 5.4 cm, and does not typically require surgical repair.  Abdominal aortic aneurysms grow slowly (usually only 2mm to 3mm per year), so small aneurysms do not require immediate repair. Small abdominal aortic aneurysms can be treated with the use of Statins to slow the rate of expansion for most patients.

Large abdominal aortic aneurysms (those with a diameter of 5.5cm or more) do require repair. The larger an aneurysm gets, the more likely it is to rupture, and the mortality rate of abdominal aortic aneurysms increases significantly with each additional centimeter an aneurysm grows.

The decision to operate on an abdominal aortic aneurysm is usually taken if:

  • There is a large aneurysm with a diameter bigger than 5.5cm
  • The patient is experiencing pain from the aneurysm, even at a smaller size
  • The aneurysm is expanding rapidly

There is the threat of rupture, or the aneurysm actually does rupture

Endovascular Abdominal Aortic Aneurysm Repair

When Not to Operate

Even with the presence of a large aneurysm, some patients choose not to have an operation, usually because they are physically not suitable for a surgical procedure. The decision not to operate might be appropriate if:

  • The patient declines surgery with full knowledge of potential consequences
  • Patient is too frail to undergo surgery due to age, or the existence of other chronic medical conditions or a combination of both

Where death is almost certainly imminent and an urgent surgical repair is likely to confer no additional benefit in the opinion of the attending surgeons

Repair Options: Open Abdominal or Endovascular?

Currently, there are two surgical options for repairing an abdominal aortic aneurysm, whether ruptured or intact.

Open Abdominal Repair

The typical procedure for an open abdominal aortic aneurysm repair involves  the following:

  • The surgeon puts the patient to sleep after running tests and scans to confirm the diagnosis
  • An incision is made in the midline on the abdomen, typically from just below the breast plate bone down to below the umbilicus
  • The bowels and part of the small intestines are pushed out of the way and a cut is made to the floor of the abdomen to access the diseased part of the aorta
  • A clamp is placed at the top of the ballooned part of the aorta and a quick cut made into the segment to open the lumen of the ballooned aorta
  • A stent or graft (synthetic material that looks like and feels like a normal aorta) is sewn into the diseased part of the aorta, above and below the ballooned segment
  • The clamps are removed and tested to ensure there is no leakage
  • The opened flaps of the ballooned segment of the aorta are sewed over the graft
  • The floor of the abdomen is repaired over the now-repaired aneurysm
  • The bowels and intestines are pushed back in place
  • The muscles and skin over the abdomen are then stitched together and the surgery is over.

The surgery takes less than an hour from the first cut to the last stitch.

After the open abdominal aortic aneurysm repair surgery, the patient is wheeled out of the theatre into the recovery room, and sleeps until he wakes up on his own. Upon waking, the patient may experience mild to moderate discomfort around the incision site. The attending anesthetist or nurse can get additional pain killers at patient’s request.

Abdominal aortic aneurysm repair surgery recovery time for an open abdominal repair is 6 to 10 weeks, the first 7 to 10 days of which patients spend in the hospital. 

Endovascular Repair

Endovascular repair (EVAR) is a minimally invasive surgery to repair AAA. EVAR does not require an intensive surgical procedure, or opening the abdomen. EVAR is increasingly used as the treatment for:

  • Abdominal aortic aneurysm repair for healthy seniors
  • Frail patients, or those with multiple co-existing medical problems
  • Those with a sudden aortic rupture, if deemed suitable by the operating vascular surgeon

EVAR offers a huge advantage over open repair because it is less invasive and a safe procedure surgeons can use to help a greater number of people. About 5% of patients discharged after a successful open abdominal repair die within the first 30 days with an open repair, while 1% of EVAR patients die within the first 30 days after surgery.

Endovascular abdominal aortic aneurysm repair involves the use of a small device to pass a graft into the ballooned part of the aorta through a pinhead-sized cut in the groin. The graft is passed through the arteries in the upper thigh or groin and allowed to “prop up” and strengthen the weak wall of the ballooned aorta segment.

Abdominal Aortic Aneurysm Repair: Tell Us Your Story!

Have you or your loved one had an abdominal aortic aneurysm repaired? Or is one being planned and you have some queries? Whatever brought you here, we would love to hear from you. Tell us your story. Share your thoughts or questions here!

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