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Aortic Aneurysm Repair

An aortic aneurysm is an abnormal bulge that occurs in the wall of the major blood vessel (aorta) that carries blood from your heart to your body. Aortic aneurysms can occur anywhere in your aorta and may be tube-shaped (fusiform) or round (saccular).

Depending on the size and rate at which your abdominal aortic aneurysm is growing, treatment may vary from watchful waiting to emergency surgery. Once an abdominal aortic aneurysm is found, doctors will closely monitor it so that surgery can be planned if it’s necessary. Emergency surgery for a ruptured abdominal aortic aneurysm can be risky.

Symptoms

Abdominal aortic aneurysms often grow slowly and usually without symptoms, making them difficult to detect. Some aneurysms will never rupture. Many start small and stay small, although many expand over time. Others expand quickly. Predicting how fast an abdominal aortic aneurysm may enlarge is difficult.

As an abdominal aortic aneurysm enlarges, some people may notice:

A pulsating feeling near the navel
Deep, constant pain in your abdomen or on the side of your abdomen
Back pain

Front view of the surgical steps of an open abdominal aortic aneurysm (AAA) repair, with stitching of aortic graft

Causes

Most aortic aneurysms occur in the part of your aorta that’s in your abdomen. Although the exact cause of abdominal aortic aneurysms is unknown, a number of factors may play a role, including:

Tobacco use

Cigarette smoking and other forms of tobacco use appear to increase your risk of aortic aneurysms. In addition to the damaging effects that smoking causes directly to the arteries, smoking contributes to the buildup of fatty plaques in your arteries (atherosclerosis) and high blood pressure. Smoking can also cause your aneurysm to grow faster by further damaging your aorta.

Hardening of the arteries (atherosclerosis)

Atherosclerosis occurs when fat and other substances build up on the lining of a blood vessel, increasing your risk of an aneurysm.

Infection in the aorta (vasculitis)

In rare cases, abdominal aortic aneurysm may be caused by an infection or inflammation that weakens a section of the aortic wall.

Abdominal aortic aneurysm repair

If you have an aneurysm that is large or growing rapidly, you’ll probably need surgery. In addition, a leaking, tender or painful aneurysm requires treatment. There are two types of surgery for abdominal aortic aneurysms.

Open-abdominal surgery

Open-abdominal surgery to repair an abdominal aortic aneurysm involves removing the damaged section of the aorta and replacing it with a synthetic tube (graft), which is sewn into place, through an open-abdominal approach. With this type of surgery, it will likely take you a month or more to fully recover.

abdominalaorticaneurysm-diagram-veinsrepairsurgical

Endovascular surgery

Endovascular surgery is a less invasive procedure sometimes used to repair an aneurysm. Doctors attach a synthetic graft to the end of a thin tube (catheter) that’s inserted through an artery in your leg and threaded up into your aorta. The graft — a woven tube covered by a metal mesh support — is placed at the site of the aneurysm and fastened in place with small hooks or pins. The graft reinforces the weakened section of the aorta to prevent rupture of the aneurysm.

Recovery time for people who have endovascular surgery is shorter than for people who have open-abdominal surgery. However, follow-up appointments are more frequent because endovascular grafts can leak. Follow-up ultrasounds are generally done every six months for the first year, and then once a year after that. Long-term survival rates are similar for both endovascular surgery and open surgery.

The options for treatment of your aneurysm will depend on a variety of factors, including location of the aneurysm, your age, kidney function and other conditions that may increase your risk of surgery or endovascular repair.

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