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Abdominal aortic aneurysm

By Dr. Sérgio Silva [email protected]

Dr Sérgio Silva is a vascular surgeon, specialising in minimally invasive surgery, at the Department of Vascular Surgery at Hospital Particular do Algarve, both in Alvor and Faro.

The aorta is the largest artery that carries blood away from the heart to the rest of the body. The abdominal aorta is the section of the aorta located in the abdomen (figure 1).

What is an aneurysm?

When the arterial wall of the aorta weakens as a result of age, disease or trauma, it may begin to bulge, causing what is called an Abdominal Aortic Aneurysm (AAA). As the aneurysm enlarges, the arterial wall weakens so that the aorta can rupture by the force from normal blood pressure, leading to massive internal bleeding. A ruptured aneurysm is a life threatening condition.

What symptoms are associated with Abdominal Aortic Aneurysms?

Most people do not experience any symptoms indicating that they may have an Abdominal Aortic Aneurysm. Most aneurysms are identified when diagnostic imaging testing (such as CT scan or ultra¬sound scan) is performed for other reasons.

What are the risk factors that can contribute to Abdominal Aortic aneurysms?

The risk of developing an AAA increases with age. Abdominal Aortic Aneurysms primarily affect people over 50 years old and are more common in men than in women. Other main risk factors include smoking and high blood pressure. Finally, a patient with a family history of AAA is at higher risk and should talk to a doctor about it.

What are the treatment options?

An Abdominal Aortic Aneurysm is treated if the doctor feels there is a risk that the aneurysm will burst (or rupture). If so, two treatment options are available depending on the physician’s diagnosis: open surgery or endovascular stent grafting.

OPEN SURGERY: The surgeon accesses the aneurysm through an incision in the abdomen. The aneurysmal portion of the vessel is replaced with a synthetic graft. The surgical procedure is often performed under general anesthesia.  

ENDOVASCULAR STENT GRAFTING: This is a minimally invasive procedure, where a stent graft, which is a synthetic tube graft supported by a metal skeleton, is placed inside the aneurysm without surgically opening, through a small incision in each upper thigh area.

Figure 2.
Figure 2.

How does a stent graft work?

The endovascular stent graft is designed to exclude the aneurysm and reinforce the weakened wall of the aorta. It reduces the risk of rupture by relieving the pressure on the aneurysm by providing a new pathway for blood flow. The stent graft is advanced and placed inside the blood vessels.

The graft is inserted through a vessel in the patient’s, groin and pushed up to the abdominal aorta (figure 2).

The stent graft procedure is performed using either region, general or local anaesthesia.

What can a patient expect after a stent graft procedure?

Immediately after recovery from the stent grafting procedure, the physician may require the patient to lie flat for four to six hours to allow the leg wounds to begin healing. Some mild discomfort may be encountered at the place of the wounds in the groin.

Placement of endovascular stent.
Placement of endovascular stent.

This usually settles within two days. Rare side effects may include swelling of the upper thigh, numbness of the legs, nausea, vomiting, leg pain or throbbing, lack of appetite, fever, and/or absence of bowel movement for one to three days.

Endovascular stent grafting requires periodic maintenance to detect any possible complications.