Frequently Asked Questions
Staff Surgeon, Department of Vascular Surgery
Specialties: Endovascular and open treatment of abdominal aortic aneurysms, thoracic aortic aneurysms and thoracoabdominal aortic aneurysms. Endovascular and open treatment of carotid artery/vertebral artery disease. Endovascular and open treatment of renal artery and mesenteric artery disease. Endovascular and open treatment of peripheral arterial disease. Stent therapy for aneurysmal and occlusive arterial disease. Thoracic outlet syndrome (venous, arterial, and neurogenic). Endovenous therapy for varicose veins. Pediatric vascular disease. Aortic aneurysm pathogenesis.
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Hello, I’m Dr. Matt Eagleton, a vascular surgeon at the Miller Family Heart & Vascular Institute. Today I would like to discuss Abdominal Aortic Aneurysms and surgical treatment options. The aorta is the largest blood vessel in the body, carrying high volumes of blood to the legs and organs of the lower body. Sometimes, a bulge forms on the abdominal aorta. We call this an abdominal aortic aneurysm, or AAA.
An AAA starts small and grows over time. It swells and stretches and fills with blood like a water balloon. Eventually, it simply bursts. The result is catastrophic internal bleeding. A ruptured AAA is usually fatal. Most people don’t even make it to the hospital. That is why AAA needs to be detected and treated early – before it ruptures.
Some 20,000 cases of AAA are diagnosed every year. It is a leading cause of death in white men over 60. The risk factors are the same as for cardiovascular disease, including smoking, high blood pressure, overweight and a sedentary lifestyle.
No one is sure what causes AAA however genetics are a factor. Fifteen to 20 percent of cases seem to run in families. If a close relative of yours has died from a ruptured aneurysm, you may be at high risk. If you smoke, have high blood pressure or any combination of these factors, you are also at high risk.
AAA has no obvious symptoms. You may have an advanced case and feel perfectly well. A ruptured aortic aneurysm may feel like a heart attack, dizziness, or back or abdominal pain. If you experience these symptoms, you need to call 911 and get to a hospital fast.
AAA is easy to detect with the right tools. The first step is to take an ultrasound. This is a non-invasive test that shows the organ structures in the abdomen. If your physician detects AAA, he or she will then order a CAT scan. This allows the physician to measure the diameter of the AAA. Size determines the course of treatment. A small aneurysm is not likely to burst anytime soon. So the usual course of action is to “watch and wait.” That means returning to the doctor to have the aneurysm measured on a regular basis. We need to know if the bulge is growing, and if so, how fast. At the same time, we address your risk factors. If you have high blood pressure, we try to lower it. If you smoke, we try to help you quit. AAA never shrinks or goes away on its own. Surgery is the only effective treatment. An aneurysm with a diameter of 2 inches or larger is at high risk of popping or bursting. An AAA of this size -- or one that is rapidly approaching this size — calls for surgery.
There are two types of surgery for AAA. The first is an open aneurysm repair. This is done through a large incision in the abdomen. We remove the aneurysm, and graft a flexible polyester tube in its place. The prosthetic blood vessel functions just like a healthy aorta. Specialized grafts are made for when an aneurysm occurs at where the aorta branches. Open aneurysm repair is major surgery. It requires total anesthesia and the stamina to undergo a long procedure. You may be in the hospital from five to ten days. Recovery can take from weeks to months. At the same time, it is also a very effective operation. Ninety-five percent of patients have a successful recovery. The grafts are very durable and can last for decades.
The other type of surgery is minimally invasive endovascular repair, or stent grafting. This procedure is done inside the artery, using long thin tubes, called catheters. The catheter is inserted through a small incision in the upper thigh, and threaded through the blood vessels to the site of the aneurysm. The catheter carries a kind of tubular mesh scaffolding called a stent. The stent expands inside the aneurysm and supports the blood vessel from within. It’s like tube within a tube. This procedure is not typically done under local anesthesia, but regional anesthesia, like an epidural. The hospital stay is two or three days. The stent graft is not as solidly placed as a graft implanted in open surgery. So you need to return routinely to make sure it is staying in place. Not all patients are eligible for stent grafting. Some aneurysms form in awkward places, or some aortas may be too twisted to allow the catheter to pass. In these cases, open surgery is the only alternative. Worldwide, the mortality for AAA procedures is about 4-5 percent. At Cleveland Clinic, mortality for AAA treatment is less than 2 percent.
There is more information about AAA and its treatment on the Miller Family Heart & Vascular Institute website. I hope that you will learn as much as you can about this serious condition, and get screening and treatment if it is appropriate. Thank you.
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This information is provided by Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.