ABDOMINAL AORTIC ANEURYSMS

INTERVENTIONAL RADIOLOGY – THE NEWER MINIMALLY INVASIVE ALTERNATIVE

Offering minimally invasive treatment for abdominal aortic aneurysms, interventional radiologists are vascular experts. The aorta, the main blood vessel that carries blood away from the heart to the rest of the body, can develop a weak area called an aortic aneurysm. Interventional radiologists are vascular experts who offer minimally invasive treatment for abdominal aortic aneurysm. An aortic aneurysm is a weak area in the aorta, the main blood vessel that carries blood from the heart to the rest of the body. As blood moves through the aorta, the frail area blows up like a balloon and can burst if it gets too large. The occurrence of abdominal aortic aneurysms (AAA) has increased over three times in the past 30 years. Abdominal Aortic Aneurysm (AAA) is caused by a weakened location in the aorta. When blood is flowing through the aorta, the blood pressure beats against the weakened area and then bulges like a balloon. If the balloon gets too large, the danger is that it will burst. Commonly, aortic aneurysms occur in the area where the renal artery begins. The aneurysm can also extend into the vessels that supply blood to the hips and pelvis regions.

If an aneurysm reaches 5 centimeters in diameter, it is necessary to treat to stop it from rupturing. If an aneurysm is less than 5 centimeters, there is less risk of it rupturing. The tumb rule is that if the diameter is more than 1.5 times the diameter of the adjacent aorta, it needs to be treated. The ideal therapy for aneurysms is to stop them from rupturing. The chances of survival are extremely low once an aneurysm has ruptured. 80 to 90 percent of patients who have an aneurysm rupture usually die. The deaths can be prevented if the aneurysm has been discovered and treated before it ruptures.

How common is an Abdominal Aortic Aneurysm ?

  • 50 percent of patients with abdominal aortic aneurysm who do not undergo treatment die of a rupture
  • Abdominal aortic aneurysm is the 17th leading cause of death worldwide, accounting for more than 15,000 deaths each year
  • Approximately one in every 250 people over the age of 50 will die of a ruptured abdominal aortic aneurysm
  • Abdominal aortic aneurysm affects as many as eight percent of people over the age of 65
  • Males are four times as likely to have abdominal aortic aneurysm than females
  • Those at highest risk are males over the age of 60 who ever smoked and/or who have a history of atherosclerosis (“hardening of the arteries”).

WHAT CAUSES ABDOMINAL AORTIC ANEURYSMS ?

  • People with a family history of abdominal aortic aneurysm are at a higher risk (particularly if the relative with abdominal aortic aneurysm was female)
  • Smokers die four times more often from ruptured aneurysms than nonsmokers

WHAT ARE THE SYMPTOMS OF AN AAA ?

Abdominal aortic aneurysm may be called a “silent killer” since there are no obvious signs of the disease, it is often disregarded as minor symptoms or seems like other less serious conditions. Seventy-five percent of aneurysms show zero symptomswhen they are diagnosed.

When symptoms are present, they may include:

  • The feeling of a “heartbeat” or pulse in the abdomen
  • Abdominal pain (that may be constant or come and go)
  • Pain in the lower back that may radiate to the buttocks, groin or legs

Once the aneurysm bursts, symptoms include:

  • Signs of shock, such as shaking, dizziness, fainting, sweating, rapid heartbeat and sudden weakness
  • Dry mouth/skin and excessive thirst
  • Severe back or abdominal pain that begins suddenly
  • Paleness
  • Nausea and vomiting

HOW IS AN AAA DIAGNOSED ?

In some casesabdominal aortic aneurysm (AAA) can be diagnosed by a physical examination in which the doctor feels the aneurysm in the abdomen around the belly button. The aneurysm pulses with each heartbeat.

The most common test to diagnose abdominal aortic aneurysm is ultrasound. Ultrasound is a painless examination in which a wand (a transducer) about the size of a computer mouse is passed over the abdomen using gel to help the sound waves create computerized images of the aorta and detect the presence of AAA. Other methods for determining the aneurysms’ size are CT scan (computerized tomography), MRI (magnetic resonance imaging), and arteriogram (real time X-rays).

HOW IS IT TREATED ?

Currently, there are three treatment options for abdominal aortic aneurysm (AAA):

Watchful Waiting

Small abdominal aortic aneurysms (AAAs) (less than 5 centimeters), that are not growing quickly or causing symptoms, have a low incidence of rupture and often require little to no treatment other than watchful waiting under the care of a vascular disease doctor. This type of care includesroutine ultrasounds during exams at regularly scheduled appointments to detect whether or not the aneurysm has grown larger.

Surgical Repair

Typical treatment for a large, non-ruptured aneurysm is to perform surgery by a vascular surgeon. This surgery involves a cut from just below the breastbone to the top of the pubic bone. After making the incision, the surgeon then closes off the aorta with a clamp; cuts open the aneurysm and sews in a graft to act as a way for the blood to flow. After this, the flow of blood then goes through the plastic graft.The graft no longer allows the direct pulsation pressure of the blood to further expand the weak area of the aorta.

Interventional Repair

This technique is not very invasive and is performed by an interventional radiologist using imaging to guide the catheter and graft inside the patient’s artery. For the minimally invasive technique, a cut is made in the skin near the groin and a catheter is passed into the femoral artery and sent towards the aortic aneurysm. By going through the catheter, the doctorplaces a stent graft that is compressed into a small diameter within the catheter. The stent graft is pushed through to the aneurysm, and thenthe aneurysm is opened.Thus, creating new walls in the blood vessel in which the blood flows.

The stent graft is still a relatively new procedure and is not recommended for everyone because there is not enough information to show that this will be a dependable repair for many years. Therefore, patients who have a life expectancy of 20 years or more may be advised against having this procedure done. Stent grafts are not custom made to fit each person. They are made in particular sizes and the patient’s body must be the right fit for each graft.

Stent Graft

A stent-graft is threaded into the blood vessel where the aneurysm is located. The stent graft is expanded like a spring to hold tightly against the wall of the blood vessel and cut off the blood supply to the aneurysm.

Efficacy and Patient Safety

Interventional repair is a treatment that can be performed safely and be most effective, resulting in lower morbidity and lower death rates than those reported for open surgery.

Recovery Time

  • Patients are often discharged the day after interventional repair, and normally do not need an intensive care stay post-op
  • Once discharged, most patients return to normal activity within two weeks after interventional repair

Benefits of Interventional Repair

  • Reduced complications
  • No abdominal surgical incision
  • Sutures only at the groins or no sutures at all
  • Quicker recovery and a shortened stay in the hospital
  • No general anesthesia in some cases
  • Less pain

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