What is an Aneurysm?

An aneurysm is a bulge or balloon that forms in the wall of a blood vessel. It is most commonly a result of an accumulation of fatty deposits on the vessel wall but may also relate to heredity, trauma or other disease that weakens the vessel wall. Over time, the vessel wall loses its elasticity, and the force of normal blood pressure in the aneurysm can lead to the rupture of the vessel. If an aneurysm forms in the part of the aorta (one of the body's main blood vessels) that extends through the abdomen, it is called an abdominal aortic aneurysm.

Some individuals are prone to dilatation of the abdominal aorta, leading to the formation of a localized bulge (aneurysm) at the point where it divides to supply the legs. Risk factors include family history, male gender, and smoking. Men are approximately eight times more likely to develop aneurysms than women are, although the ration decreases with advancing age. The sons and brothers of a man with an abdominal aortic aneurysm have roughly a one in five chance of developing aneurysms themselves. Smoking increases the chance that a genetically predisposed individual will develop an aneurysm approximately five fold.

As the aneurysm enlarges so does the risk of rupture. Aneurysms less than 5 cm (2 Inches) in diameter rarely rupture, while those larger than 6 cm have a rupture rate of roughly 30%, and those larger than 7 cm have a rupture rate that exceeds 50%.

Aneurysm rupture affects approximately 15,000 people per year making it the 13th leading cause of death in the U.S. The incidence of aortic aneurysm disease is increasing each 10 years as the population ages in general.

Most people do not experience any symptoms indicating that they may have an abdominal aneurysm. During a routine physical examination, your doctor may notice or feel a throbbing tender mass in the middle or lower part of your abdomen at about the level of the belly button, or when he/she examines your heart, gall bladder or kidneys.

A rapid growth or rupture of an abdominal aortic aneurysm may cause intense back or abdominal pain and signs of shock such as shaking, dizziness, fainting, sweating, rapid heart beat and sudden weakness. Few patients survive aneurysm rupture, hence the importance of early diagnosis and repair of the aneurysm.

Tests used to evaluate aneurysms are:

Ultrasound, which uses sound waves read by a probe that moves
along the top of your abdomen
CT ( computerized tomography) scan, which uses special x-rays
and contrast dye to show your blood vessels
MRI (magnetic resonance imaging), which uses radio waves and
strong magnet to show your blood vessels
Arteriogram, which uses x-rays and contrast dye to show blood
flow through your blood vessels

Methods of Aneurysm Repair

Open Repair

An Abdominal aortic aneurysm is treated if the doctor feels there is a risk that the aneurysm is enlarging or there is a chance of rupture. Until recently the only treatment for this type of aneurysm was a large abdominal operation where the section of the vessel where the aneurysm has formed is repaired using a fabric tube or "graft". This requires an incision from just below your breastbone to the top of your pubic bone. Patients typically spend one to two nights in the intensive care unit and are in the hospital six to eight days. Complete recovery takes 6-8 weeks.

Endovascular Repair

A recently developed alternative employs a less invasive endovascular approach. Access to the aortic aneurysm is not through the open abdomen, but through the femoral artery in each groin and the graft is not sutured into position, but pushed on the aortic wall using expandable metal cylinders (stents) and/or hooks. The combination of an endovascular graft and stents (stent graft) re-lines the aorta, bridging the gap between the no -dilated arteries above and below the aneurysm.

Stents are either balloon-expanded or self expanding. Balloon-expanded stents are forced to expand by the inflation of a balloon. Sel-expanding stents are springy. They are kept in a collapsed state bt the surrounding delivery catheter and they open up as soon as they are released.

The risk of operation depends on the patient's general health and on the type of operation. Patients with serious cardiac or pumonary disease, obese patients, and patients who have had multiple previous abdominal operations are at increased risk of complications or death if they undergo conventional surgery. These patients are more likely to tolerate encovascular repair tather than open repair.

Are you a Good candidate for the Stent Procedure?

Anyone who is considering the stent graft procedure should:

Be 18 years of age or older
Not be pregnant
Be sufficiently healthy to undergo a 2-4 hour implantation procedure
Be available to attend regularly scheduled office visits with a doctor following the procedure
Be fully informed about the risks and benefits of the stent graft procedures as compared with open surgical repair

What to expect:

After having endobvascular repair, you will remain in the hospital 2-3 days. During your stay you will be monitored and may expect some discomfort from the small groin incisions as the anesthetic medications wear off, starting on the evening after the operation. The effects of this operation include: fever and mild swelling bruising of the groin, scrotum, and penis-these all resolve without treatment. The morning after the operation the patient is able to get up and walk about. Once discharged, most people find themselves back to normal activity in about 2 weeks.

A CT scan ,ultrasound, or x-ray may be ordered before discharge to asses the results of the repair and placement of the stent. These tests show persistence of flow into the aneurysm in approximately 15% of cases. Most of these are the result of back flow through branches of the aneu;rysm, which rarely leads to aneurysm growth or rupture and need not be treated immediately. In most cases, the aneurysm shrinks slowly. If there is continued flow in the aneurysm sac (Endoleak), often times this resolves with time or can be repaired with a repeat angiogram. After surgery, the stent graft and AAA must be evaluated every 6 months to a year with ultrasound or CT scan because there is a 0-1% chance of aneurysm rupture if these devices are not monitored closely.

Your doctor will set up a schedule of follow-up visits to monitor your repair. The initial visits may be frequent then become yearly with time. The tests to monitor will be evaluated on your individual situation.

Patient ID Card

Before discharge the hospital staff will give you a Patient Implant Card. IT is important to keep this card with you and show it to future health care practitioners to inform them that you have a Vascular Graft.

Complications

Minor complications have included: wound infection, tissue necrosis along the edge of the wound, accumulation of clear fluid (lymph) beneath the skin at the wound, and accumulation of blood beneath the skin at the wound. These rarely require additional surgery. Other complications included swelling and bruising in the groin area which subsides with time.
Major complications are rare, including death, occurring in 0-3% of cases. In patients with multiple medical problems, this procedure is safer than the traditional open procedure.

When to call your doctor

If you experience any of the following symptoms contact your doctor immediately:

Pain, numbness, coldness or weakness in your legs or buttocks
Any back, chest, abdominal, or groin pain usually something new or different.
Dizziness or fainting, rapid heart beat, or sudden weakness.

New Patient Information