Abdominal Aortic Aneurysm

Most aortic aneurysms are caused by a breakdown in the proteins that provide structural strength to the wall of the aorta. Some risk factors that contribute to this structural breakdown include:

Most AAAs cause no symptoms and are often found incidentally during an evaluation for another medical condition. Dr Theivendran will take your medical history including family history, followed by a complete vascular examination. Dr Theivendran will also organise an ultrasound test. A vascular ultrasound is painless, safe and routinely used to diagnose and measure the size of an AAA. Dr Theivendran will also screen for aneurysms elsewhere in the body including the legs and chest. As there is a genetic association with AAA, Dr Theivendran will also discuss with you the merits of having immediate family members screened. Dr Theivendran may also organise a computed tomographic angiography (CTA). This test will assess aneurysm size, location and the extent of impact. This study requires exposure to radiation and injection of special dye. The CTA provides valuable anatomic information and can help Dr Theivendran determine the optimal type of repair.

Treatment depends on the size of the aneurysm and extent of symptoms.

• Small AAA’s - range from 0 - 5cm in diameter. They have a very low risk of rupturing but should be closely monitored. These usually require an ultrasound scan every 6-12 months.
  
  
• Large AAA’s - range from 5cm diameter and above. Large AAA's have a high risk of rupturing. The risk of rupture is greater than the risk of surgery so intervention is required.

In open surgery, Dr Theivendran repairs the aorta by making a large cut in the abdomen. This treatment option requires placement of a prosthetic graft where the affected portion of the aortic artery is accessed through an inclusion in your abdomen. The graft is sewn into place and acts as a replacement blood vessel.

The blood flow through the aorta is stopped while the graft is put in place. It takes roughly 3 to 4 hours to complete. Patients typically spend 1 to 2 days in ICU and usually remain in hospital for at least 7 days. Patients may require 2 to 3 months to recover completely.

Endovascular aneurysm repair (EVAR) is a less invasive treatment. Treatment here is done through two small groin incisions. Guided by X-ray imaging, a stent is placed into the artery. This stent is a fabric tube supported by a metal framework and is placed inside the aneurysm without surgically opening the tissue surrounding it. The stent is used to reline the diseased artery and exclude the aneurysm. Endovascular repair requires long-term monitoring and occasionally it is necessary to add additional stents in the future to ensure the aneurysm remains sealed.There are other considerations that may be involved in deciding if an aneurysm needs treatment or not. Dr Theivendran will go through all options and tailor an appropriate management plan for you.

This procedure is usually performed under local, regional or general anesthesia. It takes about 1 to 3 hours to complete. Patients typically spend a few hours in ICU and usually remain in the hospital for 1 to 2 days. Patients may require 4 to 6 weeks to recover completely.

Immediately after recovery from the stent grafting procedure, you may be required to lay flat for 4 to 6 hours. This will allow the leg wounds to start healing. Some mild discomfort may be felt at the wounds in the groin. This usually resolves in 2 days.