Abdominal Aortic Aneurysm

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An abdominal aortic aneurysm (AAA) occurs when a part of the aorta that passes through the belly weakens and has an abnormal widening or ballooning.

Physicians at the University of Maryland Medical Center's Center for Aortic Disease are specially-equipped to treated abdominal aortic aneurysms.

Q: What causes abdominal aortic aneurysms?

A:

The exact development of abdominal aortic aneurysms is unclear. It occurs due to the weakness in the wall of the artery and is mostly seen in males older than 60. The risk factors for the development of the AAA include smoking, high blood pressure, male gender, atherosclerosis or hardening of the arteries, and genetic factors.

Q: How is an abdominal aortic aneurysm diagnosed?

A:

Abdominal aortic aneurysms often have no symptoms and are usually detected incidentally during other tests. It can also present as a lump (mass) in the abdomen, pulsating sensation in the abdomen, or as a stiff or rigid abdomen that is usually detected during a routine examination.

An ultrasound scan is done when an abdominal aortic aneurysm with no symptoms is first suspected. A CT scan is used to confirm the size of an aneurysm.

Q: Why does this make people sick?

A:

Abdominal aortic aneurysms develop slowly over years, often with no symptoms. When people continue to have risk factors such as smoking and high blood pressure, it can expand rapidly. If it gets large enough, it can start leaking (a dissection) or tear open (a rupture). Some of the symptoms from the tearing open of the aorta are sudden, severe pain in the abdomen or back, clammy skin, dizziness, nausea and vomiting, passing out, and rapid heart rate. 

Q: How are abdominal aortic aneurysms treated?

A:

Treatment for abdominal aortic aneurysms are determined by the size of the aneurysm, presence and severity of symptoms, and the risk of surgery. If you have bleeding inside your body from the aortic aneurysm, you will need surgery right away.

Regular monitoring: Smaller aneurysms do not require surgery, but close observation is necessary to monitor its growth. Your doctor may want to check the size of the aneurysm with ultrasound tests every six months to determine the risk of bleeding from the aneurysm.

Surgery: Surgery is done when the aneurysm is bigger than two inches (5.5 cm) across or is growing fast. The goal is to do the surgery before complications develop.

  • Conventional Surgery: A vascular surgeon will perform this by making a large cut in the abdomen and then use special surgical tools to stop the blood flow in the aorta above and below the aneurysm. The section of aorta with aneurysm is then replaced with an artificial graft. The graft is sewn in place with fine stitchesand the incision is then closed. Patients are monitored in the intensive care unit after the surgery and will require a hospital stay of 7-10 days.
  • Endovascular treatment: A procedure known as endovascular aortic repair (EVAR) is done under general anesthesia. A vascular surgeon will perform this by making an incision in the groin, followed by inserting and deploying a fabric covered metal or plastic tube, called a stent, at the site of the aneurysm. This stent will provide a new pathway for the blood flow at the site of the aneurysm. It will also prevent further expansion of the aneurysm and will keep the aorta from rupturing. Patients are monitored after surgery. It usually requires a shorter hospital stay than an open repair. However, not everyone is a candidate for the endovascular treatment.

Q: What is the long-term outcome for patients with abdominal aortic aneurysms?

A:

The outcome is often good if you have the surgery to repair the aneurysm before it ruptures. When an abdominal aortic aneurysm begins to tear or rupture, it is a medical emergency. Only one in five people survive a ruptured abdominal aortic aneurysm.

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