What is an aneurysm?
An Aneurysm by definition is a focal dilation of the blood vessel. When the vessel dilates to more than 50% larger than its normal diameter it is called aneurysmal. Most AAA occur below the kidneys. The normal abdominal Aorta is typically 2.5 cm in diameter. An abdominal aorta greater than 3 cm is considered aneurysmal
What is the danger of an aneurysm ?
An aneurysm results in the weakening of the aortic wall. As the aneurysm enlarges the risk of rupture increases. The risk of rupture is low when the AAA is less than 5 cm. The risks increased significantly when it enlarges to greater than 5 cm.
In the US 15,000 deaths occur a year from Aneurysm ruptures.
Who is at risk for aneurysm?
An Aneurysm occurs more often in men then woman (4:1). The likelihood of developing an aneurysm increases as an individual ages. In the overall population the prevalence of aorta aneurysm is about 5% for those over the age of 50. If you have a first degree relative (parents or siblings) who has an AAA the likelihood you will develop a AAA is greater than 20%. Most patients who have a ruptured aneurysm do not make it to the hospital alive.
How is AAA detected?
Aneurysms can be detected by physical exam, ultrasound , CT scan or MRI. Smokers and men are more likely to develop AAA. Medicare allows men over the age of 65 who have ever smoked to have a screening abdominal aortic ultrasound.
If an Abdominal Aortic Aneurysm is detected what needs to be done?
Individuals who smoke need to understand that smoking substantially increases the risk of aneurysm growth. Individuals with AAA also have a high incidence of cardiac disease.
If the Aneurysm is less than 5 cm in diameter the patient needs to have ultrasound surveillance When the abdominal aortic Aneurysm is less than 5 cm there is a low likelihood of rupture.
As an aneurysm enlarges the aortic wall weakens. Once the AAA exceeds 5 cm, the risk of AAA rupture is about 10% in a year. If the patient is a low to moderate risk for surgery surgical intervention should be considered at this point.
How is the AAA fixed?
There are two modes of surgical treatment for aortic aneurysms, Endovascular or open surgical repair.
An endovascular repair is done through the groin using special stent grafts. With this type of procedure, the patient is usually able to eat the night of the procedure and go home the next day.
If the aneurysm is not amenable to endovascular repair it can be fixed with an open approach. In my personal experience over the last 17 years I have fixed about 800 aneurysms open and 800 aneurysms with an endovascular approach. As the graft technology advances more abdominal aortic aneurysms are candidates for the endovascular approach