Aneurysm Repair

SYMPTOMS

Abdominal aortic aneurysms often grow slowly and usually without symptoms, making them difficult to detect. Some will never rupture as they start small and stay small. Others expand quickly. Predicting how fast one will enlarge is difficult.

As an abdominal aortic aneurysm enlarges, some people may notice:

• A pulsating feeling near the navel
• Deep constant pain in the abdomen or on the side of the abdomen or on the side of the abdomen that spreads to the pelvis, legs or buttocks
• Back pain
• Clammy or sweaty skin
• Increased heart rate
• Shock or loss of consciousness
• Vomiting and nausea
• Low blood pressure

CAUSES

Although the exact cause is unknown, several factors may play a role:

• Tobacco use: Cigarettes and other forms of tobacco use appear to increase the risk. Smoking can also damage the aorta and weaken its walls
• Atherosclerosis: This occurs when plaque builds on the lining of blood vessels
• High blood pressure can damage and weaken the aorta’s walls
• Inflammatory blood vessel diseases can cause the vessels to become weak
• Bacterial or fungal infections can cause aneurysms
• Heredity: There is significant risk of AAA to run in families, especially men

RISK FACTORS

Abdominal aortic aneurysms occur most often in people age 65 and older. Other risk factors are:

• Tobacco use. The longer you smoke or chew tobacco and the more cigarettes you have smoked per day, the greater your risk
• Male
• Caucasian
• Family history of heart conditions and disease
• Other aneurysms in another large blood vessel such as the artery behind the knee may make you prone to developing an 'abdominal aortic aneurysm'

DIAGNOSIS

Abdominal aortic aneurysms are often found during an examination for another reason. One may be suspected when your doctor feels a pulsating bulge in your abdomen or during routine tests such as a chest X-ray or ultrasound of the heart ordered for other reasons. Specialized tests, such as a vascular ultrasound to map your veins and arteries, a CT scan, an abdominal ultrasound or an abdominal MRI can provide a more precise diagnosis.

TYPES OF ABDOMINAL AORTIC ANEURYSMS

Abdominal aortic aneurysms are classified into two types, according to their size and the rate by which they are growing.

Small aneurysms are less than 5.5 centimeters in diameter, generally grow slowly and have a lower risk of rupture. We generally consider it safe to monitor these with regular abdominal ultrasounds.

Large aneurysms are great than 5.5 centimeters in diameter and may be fast-growing. These are more likely to rupture and can lead to internal bleeding and other complications. The larger the aneurysm, the more likely we will have to treat it with surgery.

In addition to rupture, abdominal aortic aneurysms can also result in tears to one or more layers of the walls of the aorta. The risk of blood clots also increases as they can develop in the area of the aneurysm. If a blood clot breaks free and blocks a vessel elsewhere in your body, it can cause pain or block blood flow to the legs and toes, kidneys or abdominal organs.

ABDOMINAL AORTIC ANEURYSM REPAIR

Repair of abdominal aneurysms is generally done either through an open repair, in which a large incision is made in the abdomen to expose the aorta and repair it through a graft, or a minimally invasive endovascular aneurysm repair (EVAR). Open abdominal surgery is more invasive and can involve removing portions of your aorta. It also has a longer recovery time of up to six weeks, in some cases.

This minimally invasive endovascular procedure repairs your aneurysm from inside your damaged aorta. It involves making two small incisions in your groin area, inserting small catheters, injecting dye to be viewed on X-rays and moving a stent graft through the arteries until it reaches your aorta. Dr. Sidhu then attaches the stent graft to your blood vessel.

When positioned correctly, the stent graft expands within the artery. The wire frame pushes against the healthy portion of the aorta to seal the device in place. Once in place, blood flows through the stent graft and cannot enter the aneurysm. Some patients may also require a puncture or small incision into an artery in the upper arm.

Performing a repair through EVAR is preferred because the procedure is quick, involves less stress on the body and has a lower risk of developing lung, heart or abdominal problems or developing an infection when compared with an open procedure. recovery time is about two weeks.

POST SURGICAL RISKS

As with any procedure, EVAR has risks that can include:

• Damage to surrounding blood vessels organs or other structure
  Kidney damage
• Loss of blood flow to legs or feet from a blood clot
• Groin wound infection
• Groin hematoma
• Bleeding
• Spinal cord injury
• Fracture or movement of the stent graft from its original site of placement
• An endoleak, which is the continual leaking blood out of the graft and into the aneurysm sac is a unique complication that must be repaired as it can continue to lead to the potential for rupture.

For the compassionate care you deserve, come to Vein, Vascular, Primary Care & Aesthetic Associates, serving the communities of Everett, Issaquah, Kirkland, Newcastle, Seattle and Sammamish. For your convenience, you can use our online Request an Appointment form.