Abdominal Aortic Aneurysm

What Is an Abdominal Aortic Aneurysm (AAA)?

An abdominal aortic aneurysm (AAA) is a weak area in the wall of the abdominal aorta - the artery that carries blood from the heart to the rest of the body. The aorta is the body’s largest blood vessel; when an area is weak, it may bulge like a balloon when blood flows through it. The most common site for an aortic aneurysm to occur is below where the aorta divides to supply blood to the kidneys and above where it divides to supply blood to the pelvis and legs. An aneurysm that occurs in this location is called an abdominal aortic aneurysm. The normal diameter of the aorta is about 1 inch or less. Small aneurysms - less than 2 inches (5 centimeters) rarely rupture and may pose little risk to the patient. If the aneurysm grows larger, however, the risk of rupture and life-threatening bleeding (hemorrhage) increases. In most cases, physicians recommend treating aneurysms that are 5.5 centimeters or greater in diameter. These aneurysms can result from accidents, atherosclerosis, high blood pressure or inherited disease.

How Common is AAA?

Abdominal Aortic Aneurysms, the 13th leading cause of death in the United States, are found in an estimated 1.5 million Americans. Because people with AAA, usually men over 55, are typically asymptomatic, only about 200,000 are diagnosed each year. About 15,000 people die of AAA in the U.S. every year. Approximately one in every 250 people over the age of 50 will die of a ruptured AAA. Fortunately, when AAA is diagnosed early it can be successfully treated and rupture is prevented. Depending on the individual, treatment may require surgery. Often, however, the aneurysm can be repaired with a new technique that does not require open surgery.

What Symptoms Are Associated With Abdominal Aortic Aneurysms?

AAA is often a silent disease. Many patients do not experience any symptoms, particularly when the aneurysm is small. If there are symptoms, the most common ones are:

• Intense abdominal pain that may be constant or come and go.

• Pain in the lower back that may radiate to the buttocks, groin or legs

• The feeling of a "heart beat" or pulse in the abdomen.

• Fatigue

• Sometimes, the aneurysm can be felt as a soft mass in the abdomen.
  

If an aneurysm expands rapidly, tears open, or bursts, or if blood leaks along the wall of the blood vessel (aortic dissection), more severe symptoms may develop suddenly. A ruptured aneurysm is life-threatening and requires immediate emergency care.

Symptoms of a ruptured aneurysm may include:

• Severe pain that begins suddenly

• Paleness

• Rapid pulse

• Dry mouth/skin and excessive thirst

• Anxiety

• Nausea and vomiting

• Lightheadedness or fainting

• Excessive sweating or clammy skin

• Shock

How is AAA Diagnosed?

A careful physical examination can detect as many as 70 percent to 80 percent of abdominal aortic aneurysms. By placing a stethoscope on the abdomen, the doctor often can hear the sounds of abnormal blood flow through the roughened surface of the aorta. The doctor also may be able to feel the aneurysm by pressing gently on the abdomen. If your physician suspects that you have an AAA, further diagnostic tests will be performed.

There are a number of imaging exams that can be used to "see" and diagnose an abdominal aortic aneurysm. Your doctor may recommend one or more of the following tests:

• An X-ray of the abdomen

• An ultrasound exam

• Magnetic resonance imaging (MRI)

• Computed tomography (CT or "CAT" scan)
  

Once an aneurysm has been diagnosed, the treatment will depend on a number of factors, such as the size of the aneurysm and the overall health of the patient. Small aneurysms of less than 2 inches (5 centimeters) in diameter rarely rupture and may pose little risk. If the aneurysm grows to 5.5 centimeters or larger, however, physicians usually recommend treating them with surgery or with non-surgical stent-graft repair.

What are the Treatment Options?

There are three basic treatment options:

1. Do nothing except follow the AAA with serial ultrasounds. This is sometimes the best choice if the AAA is small and the patient is elderly and or very high risk.

2. Conventional Surgery.

3. Endoluminal Stent-Graft Repair.
   

What Is the Current Treatment Method Used for Repair of Abdominal Aortic Aneurysms?

An abdominal aortic aneurysm is treated if the doctor feels there is a risk that the aneurysm will burst. Currently, the standard treatment is conventional surgery. The surgery is performed to replace the section of the vessel where the aneurysm has formed. The surgical procedure is performed under general anesthesia and takes about three to four hours to complete. The surgeon accesses the aneurysm through an incision in the abdomen.

The aneurysmal portion of the vessel is excluded (shut off from the main part) and replaced with a synthetic graft, which is sewn into place. Patients typically spend one night in an intensive care unit and remain in the hospital for an additional five to seven days.

Is There an Alternative Treatment to Conventional Surgery?

Yes, there is an alternative treatment known as "endovascular stent grafting." Endoluminal Stent-Graft Repair is a new endovascular technology for repairing abdominal aortic aneurysms using minimally invasive surgery. It uses a Stent which is attached to a Vascular Graft, which is similar to the graft material used for Conventional Surgery. The graft material is made from polyester cloth and has specially designed metal attachment systems (Stents) that act like the sutures which are used to sew a Vascular Graft to the Aorta during Conventional Surgery. The main difference between Conventional Surgery and Endoluminal Stent-Graft Repair is in the way the graft is placed inside your aorta and the way it is attached to the walls of your aorta.

Are You a Good Candidate for the Endoluminal Stent-Graft Procedure?

Anyone who is considering the Stent Graft procedure should:

• Be 18 years of age or older.

• Not be pregnant.

• Be sufficiently healthy to undergo a two to four hour implantation procedure.

• Be available to attend regularly scheduled office visits with a doctor following the procedure.

• Be fully informed about the risks and benefits of the AneuRx stent graft procedure as compared to open surgical repair.

• Have acceptable blood vessels to accept delivery catheter for procedure success.
  

Patients having very large aneurysms and/or aneurysms or vessels that are very angled may not be good candidates for treatment using a Stent Graft. Since not all patients are good candidates for this type of treatment, it is very important that you speak to your doctor about your reasons for wanting to be treated with Endoluminal Stent-Graft and ask if you would be a good candidate.

How Is the Endoluminal Stent-Graft Procedure Performed?

The AneuRx Stent Graft procedure is performed using either regional or general anesthesia. Before the procedure, a number of diagnostic tests are performed. These diagnostic tests allow the doctor to visualize the aneurysm and the surrounding area. To prepare for the procedure, a small incision is made in each upper thigh area. Using fluoroscopy for visual guidance, the delivery catheter is advanced through the large blood vessel in your thigh to the aneurysm site in your abdomen. When the delivery catheter is properly positioned inside the aneurysm, the Stent Graft is released from the delivery catheter into the blood vessel. When the stent graft comes into contact with blood, it expands to a preset size. After expansion of the stent graft, the delivery catheter is withdrawn and removed. Depending on the shape and size of your aneurysm, additional stent grafts may be placed to assure that the aneurysm is completely reinforced. X-rays and/or intravascular ultrasound imaging procedures are performed to allow the doctor to verify that the stent graft is properly placed within the aneurysm. The procedure typically takes between two to four hours to complete.

What Can I Expect After the Endoluminal Stent-Graft Procedure?

Patients have reported feeling some discomfort for the first few days following the procedure. Immediately after recovery from the surgical procedure, your physician may require you to lay flat for four to six hours to allow the leg wounds to begin healing. You may experience side effects such as swelling of the upper thigh, numbness of the legs, nausea, vomiting, leg pain or throbbing, malaise, lack of appetite and/or absence of bowel movement for one to three days.

Benefits of the Endoluminal Stent-Graft Procedure

The Endoluminal Stent-Graft System is effective in the treatment of abdominal aortic aneurysms. Treatment with the Endoluminal Stent-Graft allows:

• An alternative to open surgery.

• Reduction or elimination of general anesthesia and mechanical ventilation.

• Reduction or elimination in the amount of time that blood flow is decreased to vital organs and lower extremities.

• Reduction or elimination of the complications that may result from open surgery.

• Reduction of hospitalization and recovery time.

• Reduction in the amount of blood loss and blood transfusions required.

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