Aortic Aneurysm

An aneurysm is a swelling in a blood vessel indicating a weakness or thinning of the blood vessel wall. One of the most common aneurysms is an aortic aneurysm. The aorta is the main artery in your body. It travels through the chest and along the back of the belly. At the level of the belly button, it splits into the two iliac arteries that go to each leg.

The most common location for an aortic aneurysm is in the abdomen below the artery branches going to the kidneys. The aorta normally measures 2.5 centimeters (one inch) in diameter in this location. If the aorta widens to 3 centimeters or more, it is considered to be an abdominal aortic aneurysm, or AAA, or “triple A.” Like a balloon, the larger and larger an aneurysm gets, the greater the risk of rupture. Most people who have a ruptured AAA do not survive.

Risk factors for AAA

  • Male gender
  • Age over 65
  • High blood pressure
  • Family history of aneurysm
  • Past or present smoking habit (over 100 packs)

Five to 8 percent of men over the age of 60, and 30 percent of men over the age of 80 have aneurysms.

We advise fixing AAAs when they reach 5 centimeters in diameter or more. At 5 centimeters, the risk of rupture is 3 to 5 percent yearly; at 6 centimeters, the risk is 12 percent yearly, and at 7 centimeters, the risk is 25 percent yearly. There are two ways of fixing aneurysms: open surgery and endovascular stenting. The choice of approach depends on the aneurysm, the patient’s overall health, and the results of preoperative testing.

Open Surgery for AAA

Some aneurysms are best fixed through open surgery. The surgeon makes an incision down the center of the abdomen. Blood flow through the aneurysm is temporarily stopped with clamps on the vessel above and below. The aneurysm is opened lengthwise and a tube graft is hand sewn into the artery above and below the aneurysm. The aneurysm wall is then closed over the top of the graft to protect it. The graft is permanent and, over time, the body forms a normal-looking artery lining inside it.

This surgery takes two to three hours and is performed under a general anesthetic. Some people require a blood transfusion. After surgery, patients are monitored in Intensive Care. The typical hospital stay is three to five days, depending on pain control and how long it takes for the intestines to resume normal function following surgery.

EVAR or Stent Grafting

Abdominal Endovascular Aneurysm Repair (EVAR) is a minimally invasive alternative to major open surgery for the repair of abdominal aortic aneurysms. This surgery involves placing a stent graft into the artery to create an internal bypass through the aneurysm. The device is deployed through small incisions in the groin. Guided by a real-time imaging, the surgeon manipulates wires and catheters through the arteries. The stent graft is collapsed into a tube, which is inserted into the arteries under fluoroscopy (continuous X-ray). When the device is properly positioned inside the aneurism, it is deployed. The metal stent is fixed to the normal artery above and below the aneurysm, creating an internal bypass. Blood then flows through the stent graft. There is no blood flow through the aneurysm so it will not grow or rupture. Over time, the outer wall of the aneurysm sac shrinks down around the graft.

This surgery was initially introduced for people who were too sick to consider open aneurysm repair, but we now consider this approach for most people with aneurysms. However, treatment is individualized and some people are not good candidates for EVAR.

For most people, EVAR takes about two to three hours. Typically, we use a light general anesthetic. Most people do not require blood transfusion, and most people leave the hospital the day following surgery.

Risks of EVAR vs Open Surgery for AAA

Open surgery is considered a more major procedure than EVAR because of the strain on the heart and lungs during surgery.

Potential Risks for Surgery or EVAR

  • Heart Attack
  • Arrhythmia (abnormal heart rhythm)
  • Prolonged Intubation
  • Pneumonia
  • Kidney Failure
  • Infection
  • Stroke
  • Bleeding
  • Distal Embolization

We have performed more than 150 EVAR procedures with a complication rate of less than 5 percent.