Patients

Patients

AAA: Abdominal Aortic Aneurysm

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The aorta is the largest blood vessel in your body. It carries blood from the chest to the abdomen where it branches into the iliac arteries, which carry blood to the lower body and legs.

An abdominal aortic aneurysm (AAA) occurs when the portion of the aorta passing through the abdomen bulges because of weakening of the vessel wall. An aneurysm means the walls of the artery have stretched and become thin causing the vessel to bulge or expand. This weakens the vessel wall and affects its ability to support normal blood flow. If an AAA bursts, it can cause internal bleeding–a serious and potentially life threatening condition.

ABDOMINAL AORTIC ANEURSYM

Prevalence & Rupture Risk

Prevalence in males is 5 times that of women, while rupture risk is greater for women than men.*

Prevalence1
WOMEN
1.1%
MEN
5.5%
Rupture Risk (unscreened)1
WOMEN
5.7%
MEN
1.9%

* 65 years and older
1 Wanhainen et al, Cost-effectiveness of screening women for abdominal aortic aneurysm. JVS 43:5; 2005

Symptoms

Some patients with AAA don’t have any
symptoms. Others might experience:

SCREENING

The U.S. Preventative Services Task Force and the American Academy of Family Physicians recommend AAA screening for:

  • Men aged 65 to 75 y who have ever smoked*
    Screen once for abdominal aortic aneurysm (AAA) by ultrasonography.
  • Men aged 65 to 75 y who have never smoked
    Selectively screen for AAA.
  • Women aged 65 to 75 y who have ever smoked*
    Inconclusive. No recommendation.

* “Ever smoked” is defined as having smoked at least 100 cigarettes during a lifetime.

Risk Assessment: Risk factors for AAA include older age; a positive smoking history; having a first-degree relative with an AAA; and having a history of other vascular aneurysms, coronary artery disease, cerebrovascular disease, atherosclerosis, hypercholesterolemia, obesity, or hypertension.

Factors associated with a reduced risk for AAA include African American race, Hispanic ethnicity, and diabetes.

LeFevre ML.  Screening for Abdominal Aortic Aneurysm: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med 2014; 161:281-290.
Keisler B, et. Al. Abdominal Aortic Aneurysm. Am Fam Physician 2015; 91:538-543.

Senior Patient And Doctor Have Consultation In Hospital Room

Diagnosis

AAA may be detected during a routine physical when feeling your abdomen, with a chest x-ray or ultrasound.

If your doctor suspects an AAA, you may need additional testing by:

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ANGIOGRAM

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CT SCAN
Computed Tomography Scan

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MRI
Magnetic Resonance Imaging

These tests can show the location, shape, and size of your aneurysm.

Treatment

Regular Examinations with ultrasounds (if AAA is less than 5 cm) to monitor the condition

Abdominal Surgery (also called Open Repair) is performed under general anesthesia to access the aorta through an incision in your abdomen. The damaged section of the aorta is removed and a fabric tube called a graft is stitched in its place. The surgery usually takes 2-4 hours and requires a hospital stay of 5-7 days. Your recovery may take 3 months or longer.

Advantages
  • Standard treatment
  • Effective
  • Lasting results
  • Long-term follow up isn’t needed
Disadvantages
  • General anesthesia required
  • Major surgery, large incision
  • Higher complication rate than endovascular aneurysm repair
  • Longer hospital stay and recovery
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Endovascular Aneurysm Repair (EVAR) is a minimally invasive procedure that accesses the aorta through a small incision in your groin. Thin wires are inserted through the femoral arteries and act as a guide for a long, thin tube called a catheter. A stent is delivered through the catheter to the site of the aneurysm and expands to reinforce the damaged portion of the aorta. The wire and catheter will be removed, the doctor will confirm that the stent is in the proper position, and the incision will be closed with a few stitches or sutures. The stent will remain in place permanently. The procedure takes 1-3 hours to complete and requires a hospital stay of a few days.

Advantages
  • Minimally invasive procedure
  • Local anesthesia
  • Small incisions
  • Lower complication rate than surgery
  • Shorter hospital stay, recovery
Disadvantages
  • Higher potential for complications
  • Long-term follow up required
  • Possibility of additional procedures
Low Angle View Of Four Surgeons

Percutaneous Endovascular Aneurysm Repair (PEVAR) accesses your femoral artery through a small puncture in your groin area. Thin wires are inserted through the femoral arteries and act as a guide for a long, thin tube called a catheter. A stent is delivered through the catheter to the site of the aneurysm and expands to reinforce the damaged portion of the aorta. The wire and catheter will be removed. The doctor will confirm that the stent is in the proper position and pressure will be applied to the puncture site to control any bleeding. The stent will remain in place permanently. The procedure takes 1-3 hours to complete and requires a hospital stay of a few days.

Advantages
  • Minimally invasive procedure
  • Local anesthesia
  • Small punctures
  • Lower complication rate than surgery
  • Shorter hospital stay, recovery
Disadvantages
  • Higher potential for complications
  • Long-term follow up required
  • Possibility of additional procedures
Nurse Pushing Senior Patient In Wheelchair Along Corridor

Aftercare

ABDOMINAL SURGERY

Following abdominal surgery, you may need a ventilator to help with your breathing. Once you can breathe on your own, you will be asked to cough occasionally to keep fluid from collecting in your lungs. You will have a drainage tube in your stomach and will not be able to eat or drink until it is removed, usually a few days after the procedure. Gradually you will be able to get out of bed, walk, and return to eating solid foods. Recovery from abdominal surgical repair takes approximately 3 months and will require a follow up visit with your doctor.

Call your doctor if you experience any of the following:

  • Fever or chills
  • Redness, bleeding, drainage or swelling of your incision
  • Increased pain around the incision

EVAR OR PEVAR

After an EVAR or PEVAR procedure, you will be given pain medication if needed and will be able to gradually get out of bed, walk, and eat solid foods. You may feel well enough to resume your normal activities in 4 to 6 weeks. Endovascular repair means you will need regular follow up visits with your doctor: a month afterward, at six months, and each year following your procedure. The visits will include a physical exam and an ultrasound, CT scan, or angiography to check for any changes.

Call your doctor if you experience any of the following:

  • Pain in the legs, back, chest or abdomen
  • Numbness in the legs, back, chest, or abdomen
  • Weakness in the legs, back, chest, or abdomen
  • Dizziness
  • Fainting
  • Rapid heartbeat
  • Sudden weakness
  • Discoloration or coolness in the leg

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