Aorta is the main blood vessel supplying blood from heart to chest and abdomen. Abdominal Aortic Aneurysm (AAA) is an enlarged area in the lower part of the aorta, if left untreated wall of aorta could become very weak and rupture. As aorta is the major blood supplier, a ruptured Abdominal Aortic Aneurysm can cause bleeding which may be life threatening.
Causes of Abdominal Aortic Aneurysm
Exact cause is unknown, a number of factors may play a role
- Age- Abdominal aortic aneurysms usually seen in older people above age 65
- Gender– more often seen in men
- Family history- People who have a family history of abdominal aortic aneurysms are at increased risk .
- High blood pressure- High blood pressure increases chances of developing an abdominal aortic aneurysm.
- Cigarette smoking- Smoking can be damaging to the aorta and weaken the aorta's walls.
- Atherosclerosis- increases risk of an aneurysm.
- Infection in the aorta
Asymptomatic initially and grow slowly. Few AAA stay small, others expand quickly.
- As an abdominal aortic aneurysm enlarges
- Pulsating feeling near the navel
- Back pain
- Deep, constant pain in your abdomen
Signs and Symptoms of Ruptured Aortic Aneurysm
- Sudden, intense and persistent abdominal or back pain
- Sweatiness, Dizziness
- Nausea, Vomiting
- Low blood pressure, Fast pulse
Test and Diagnosis
- Physical examination- a palpable and pulsatile abdominal mass is noted
- Ultrasound- commonly used to diagnose abdominal aortic aneurysms.
- Computerized tomography (CT) scan- provides clear images of your aorta, and it can detect the size and shape of an aneurysm.
- Magnetic resonance imaging (MRI)- An MRI is a painless imaging test that may be used to diagnose an aneurysm and determine its size and location.
Treatment of AAA (Abdominal Aortic Aneurysm)
Treatment type depends on the size of the aortic aneurysm and how fast it's growing and other co-morbid conditions. In cases of rupture of AAA it is treated with emergency surgery and has a low survival rate, it is always advised to have surgery initially if it's large to prevent rupture.
Medication - No medical therapy has been found to be effective at treatment of AAA
Medical surveillance - If abdominal aortic aneurysm is small with no symptoms, you will be advised monitoring with regular check ups
Surgery- Surgery is generally recommended if size of aneurysm is large, if the aneurysm is growing quickly or if you're experiencing symptoms.
Open Abdominal Surgery
It is the traditional method of repair of AAA.
OAS indicated in patients
- who have previously undergone EVAR but need further treatment.
- required in cases of EVAR graft infection
- Performed under general anaesthesia
- Surgeon makes incision in abdomen to reach aorta
- Aorta is opened and graft is sutured inside the aneurysm
- Aneurysm sac closed back into graft and blood conducted through graft
- Incision in abdomen stitched
- Recovery time after OAS is long
- Patient in hospital for 7-10 days
Complications of Open Surgery
- Blood clot
- Patient explained about the surgery
- General tests performed before surgery
- Adviced to stop certain medications
- Endovascular surgery is a less invasive procedure, Surgeon puts in stent graft inside the aneurysm.
- Performed by Vascular surgeon under general, spinal or local anaesthesia.
- Catheter is passed through artery in leg to the aneurysm, Guided using X-ray the compressed stent is passed through catheter and expanded to fit the aneurysm
- Stent protects the aorta wall from pressure and keeps the aorta open, and prevent rupture of the aneurysm.
- Hospital stay around 2-3 days
- Recovery time is generally shorter less than 2 weeks
- Regular follow-up imaging tests to ensure that the graft isn't leaking.
- Adviced to avoid heavy lifting and vigorous physical activity putting additional pressure on your aneurysm.
- To keep your blood pressure levels from going too high.
- leaking or out of position graft
- infection of the graft
- blood clot
- heart attack or stroke
Long-term survival rates are good for both endovascular surgery and open surgery.
Factors affecting the treatment cost of Abdominal Aortic Aneurysm
Cost to the patient depends on variety of factors like:
- The hospital patient chooses
- Fees for the team of doctors
- Cost of tests and diagnostic procedure
- Cost of procedure performed
- Cost of graft
- Cost of follow-up care required