Aneurysm
What is an Aneurysm?
While PAD describes a series of conditions where arteries are partially or completely obstructed, aneurysms arise from areas of weakening of the artery resulting in a ballooning out of the vessel wall. Aneurysms occur mostly in the aorta (the largest artery in the body, starting up at the top of the heart and passing down through the chest and abdomen, dividing into left and right-sided iliac arteries in the pelvis) — most commonly in the abdominal aorta roughly at the level of the bellybutton.
Once aneurysms develop they generally continue to grow and, at a certain size, have a risk of rupturing. The internal bleeding that results is often lethal. Accordingly, vascular specialists try to identify aneurysms as soon as possible. They occur after the age of 50, more commonly in men and particularly in those individuals with a family history of aneurysm or who have been cigarette smokers. Aneurysms conventionally are examined with ultrasound every 6-12 months, and treatment will generally be advised when the aneurysm grows to exceed 5.5 cm (a little over 2 inches) in diameter.
Historically aneurysms were treated by means of a large abdominal incision, with the replacement of the weakened aorta by a plastic graft. While this approach is still recommended in certain circumstances, these days aortic aneurysms are much more commonly treated by catheter techniques, whereby a plastic tube, supported by stents (“aortic endograft”), is inserted across the aneurysm, thus excluding the weakened aneurysm wall. Such an approach is much less invasive than the open surgical technique: Just as for treatment of PAD, however, the approach is less durable and requires periodic post-procedure surveillance, usually by abdominal ultrasound or CT scan.
An aneurysm is an enlarged segment of an artery caused by the weakening of the arterial wall. An aneurysm may occur in any segment of an artery anywhere in your body. Most aneurysms are clinically silent or without symptoms. A fast-growing aneurysm in the abdomen sometimes can present with symptoms such as abdominal pain, lower back pain, or a pulsating sensation in the abdomen if the patient is thin.
- The aorta is a main blood vessel that carries oxygenated blood from your heart to the different parts of the body. It extends from the chest to the abdomen and then divides into the iliac arteries. The iliac arteries then supply the lower part of the body and the legs.
- When the wall of the artery weakens it will balloon and stretch out and this is called an aneurysm. It can happen anywhere along the length of the aorta and the iliac arteries. If the wall weakens at the segment of the aorta where it supplies the abdomen it is called an abdominal aortic aneurysm. The risk for rupture of the aneurysm is related to the size of the aneurysm.
Risk Factors:
- Positive family history of aneurysms
- Smoking
- High blood pressure
- Heart disease
- More common in males than females
- Advancing age
Symptoms:
- Most patients have no symptoms
- Symptoms if present are pain in the abdomen, chest, or back
- Sometimes you are able to feel a throbbing or pulsatile mass in your abdomen
- If the AAA ruptures, you will go into shock due to the bleeding and it is life-threatening
Diagnosis:
AAA can be discovered with a physical exam when the doctor may feel a bulge or pulsation in the abdomen. Most aneurysms are found during medical tests like ultrasounds, CT scans done for other medical conditions.
Imaging Tests
An abdominal ultrasound is commonly used to screen for aneurysms and for routine monitoring. It is non-invasive, cost-effective, and safe. Computed Tomographic Angiography (CTA) – will assess aneurysm size, location, and extent of the impact. This study requires exposure to radiation and injection of an intravenous contrast material.
Treatment
Medical Management:
It is important to stop smoking, manage your blood sugar, cholesterol, and blood pressure levels if elevated with appropriate medical therapies as it contributes to the growth of the aneurysm.
Surgical Management:
The aneurysm can be considered for repair with an endovascular or an open surgical approach.
Endovascular Repair of AAA:
This is a minimally invasive technique of treating an aneurysm. It involves making a small incision or cut in both the groin or near the hip to insert a fabric tube and it is positioned in such a way as to seal off the aneurysm and the graft (the fabric tube) becomes the new wall of the aorta through which the blood will flow through. Because this type of repair only involves small cuts in the groin/hip it usually only requires a short hospital stay and recovery time is shorter. You are able to return to your normal activities in 4 – 6 weeks after the procedure.
Open Surgical Repair of the Aneurysm:
In this approach, a cut is made through the abdomen to reach the aorta for the repair of the aneurysm. The graft or the fabric tube is sewn in place of the wall where the aneurysm was identified and that acts as the new wall for the blood vessel through which blood will flow through. The surgery will take around 2-4 hours and involves a longer hospital stay and recovery period. It may take up to 3 months post the surgery to return to your normal activities.
Based on the size, location, shape of the aneurysm, your medical history, and risks your vascular surgeon will discuss the best treatment plan.