Abdominal Aortic Aneurysm (AAA)
The abdominal aorta is approximately 2 cm wide and 13 cm in length. It begins where the aorta passes through the diaphragm and ends where it splits to become the right and left common iliac (thigh) arteries, which is just below the “belly button” for most people. As it carries blood through the abdomen to the lower extremities, it branches out to supply blood to vital organs, muscles, and glands in the abdomen. Its blood flow is essential to the kidneys, liver, pancreas, spine, and gastrointestinal system. A description of abdominal aortic aneurysm (AAA) disease can be found here.
Indications for Surgery
Treatment is determined by the size and location of the AAA in consideration with the patient’s overall health. Although they are serious, AAAs may not be immediately life-threatening; they are often watched until they become 5 cm in diameter, continue to grow, or cause symptoms. Surgery is necessary to prevent the AAA from bursting. Smaller, stable aneurysms in the descending aorta or abdominal aorta are watched and reevaluated at regular intervals. AAAs that do not grow or worsen are left untreated; however blood pressure—lowering medicine may be prescribed to relieve stress on the aortic walls, and smokers who develop a AAA are urged to quit smoking. Nonsurgical treatment is especially helpful for patients who are not good candidates for surgery.
The surgery to repair AAA is called an open aneurysm repair. It is a major surgery that is performed under general anesthesia by a vascular surgeon. The procedure takes 3 to 6 hours and is more than 90 percent effective. The surgeon makes a long abdominal incision and then completely removes and replaces the damaged part of the aorta with a synthetic (Dacron or Teflon) tube graft that becomes a part of the body as it heals. The graft also reinforces the aorta to prevent recurrence of the aneurysm. The recovery period includes 4 to 7 days in the hospital followed by 6 to 12 weeks of healing time.
Endovascular AAA Repair
Endovascular AAA repair is a less invasive option for treating AAA. This technology, in common use since the early 2000s, has augmented treatment options rather than replaced open surgical repair. Patients who previously were not candidates for repair due to health reasons may now be treated with endovascular repair.
The Society for Vascular Surgery www.vascularweb.org/patients/NorthPoint/Abdominal_Aortic_Aneurysm.html
Texas Heart Institute www.texasheartinstitute.com/HIC/Topics/Cond/Aneurysm.cfm
Zarins CK, Wolf YG, Lee WA, et al. Will endovascular repair replace open surgery for abdominal aortic aneurysm repair? Ann Surg 2000 Oct;232(4):501-507.
Moore, KL. Clinically Oriented Anatomy, 2nd Ed. Baltimore, MD: Williams & Wilkins, 1985.