Abdominal Aortic Aneurysms
An aneurysm is an enlargement, usually localized, of an artery to more than twice its normal diameter. Depending upon the artery involved, an aneurysm can commonly cause symptoms by rupture, leading to catastrophic hemorrhage. Alternatively, occlusion of the aneurysm or embolization (dislodgement) of particulate material from within it may occur, and either outcome can lead to impairment in blood flow to the organ supplied by the involved artery. Aneurysms may be caused by infection or trauma but most commonly are due to idiopathic (unexplained) degeneration of the arterial wall and are sometimes associated with atherosclerosis. Aneurysms may involve any artery but the abdominal aorta is most commonly involved.
The major risk for untreated aneurysms in this location is rupture, and this threat increases with aneurysm diameter. For this reason, repair of abdominal aortic aneurysms is indicated for large or enlarging aneurysms or for those that are causing symptoms. Mortality and complication rates for patients undergoing repair of aortic aneurysms are dramatically less for elective operations performed before the aneurysm ruptures than for those procedures performed emergently because of impending or frank rupture with hemorrhage. The complication rates also may be different from one hospital to another or one surgeon to the next depending upon the experience and background of the surgical team. Patients under consideration for aneurysm repair should request information regarding their chance for complications in the particular setting in which their aneurysm is to be treated.
Treatment: Aortic aneurysms can be repaired in a standard open surgical fashion or by endovascular means (EVAR) using stent grafts. EVAR has had its greatest value in the treatment of patients who are very elderly or too infirm to tolerate a major open surgical procedure. Our vascular surgeons have extensive experience with both of these techniques.
