The goals of treatment are to:
- Prevent the aneurysm from growing
- Prevent or reverse damage to other body parts
- Prevent or treat a rupture
- Allow you to continue to go about your normal daily activities.
Sometimes, small aneurysms that are not causing any pain -- and are not in danger of rupturing -- can be managed with observation or "watchful waiting."
Keep a Close Eye
This means keeping a close eye on the aneurysm to make sure it is not getting any bigger or any closer to rupturing.
If you have a small aneurysm, your doctor may ask you to come back every six to 12 months for one of the above listed tests to measure the size of the aneurysm and to review any symptoms to see if they have gotten any worse. Usually, this method is used for aneurysms smaller than about 2 inches (5 centimeters) in diameter -- about the size of a lemon.
Have Regular Checks
But an aneurysm will not go away on its own. It is extremely important to have regular checks to make sure the aneurysm does not grow to a dangerous size over time.
Control High Blood Pressure and Cholesterol
Although no medicine exists to treat aneurysms, controlling high blood pressure with appropriate medications and reducing cholesterol are important to try to reduce the rate of enlargement.
Smoking cessation is also critical since continued smoking has been associated with an increased chance of continued aneurysm enlargement and rupture.
Open Surgical Aneurysm Repair
The traditional approach to correcting an abdominal aortic aneurysm is open surgical repair. At the CardioVascular Institute, approximately 42% of AAAs are treated in this way.
Major Incision in Abdomen
Open surgery involves a major incision in the abdomen or flank and general anesthesia is required.
Most aneurysms are treated when they reach a size where the risk of rupture becomes significant (about 5.5 cm in diameter in a man, 4.5-5cm in a woman). A few are treated for symptoms of back or abdominal pain.
Factors to Consider
When deciding on surgery, in addition to the size of the aneurysm, the doctor considers a variety of other factors, including your age, general health, symptoms, and other illnesses you may have, especially heart disease.
Graft Replaces Damaged Section of Aorta
In the surgery, the aneurysm is taken out and the section of the aorta is replaced with a tube-like artificial graft made of Dacron or Teflon material and shaped and sized just like a healthy aorta. It takes the place of the removed, damaged section of your aorta and allows blood to pass through it easily.
Hospital Stay and Recovery Time
The operation usually takes about three hours and you may need to stay in the hospital four to eight days. Although this may vary, complete recovery can take as long as three to six months.
Experienced Surgeons at CardioVascular Institute
As with any operation, there are risks and you will want to discuss those with your doctor. However, in most patients, aneurysm surgery is safe and very effective when performed by experienced surgeons in high volume centers like the CardioVascular Institute.
Endovascular Aneurysm Repair
Less Invasive than Traditional Surgery
In certain cases your surgeon may recommend a newer procedure called an endovascular aneurysm repair (EVAR). The procedure is less invasive than traditional surgery.
Small Incision in the Groin
In EVAR, the aneurysm is not removed. Small incisions are made in the groin to expose the femoral arteries.
Strent Graft Eliminates Risk of Rupture
Through these arteries, a specially designed expandable wire mesh tube covered with Dacron or Teflon known as a stent graft is passed into the aneurysm using specialized x-ray imaging equipment where it is released and expanded.
The stent graft lines the inside of the aneurysm, like a pipe within a pipe. It both reinforces the weakened part of the vessel from the inside and excludes the aneurysm from blood flow, eliminating the risk of rupture.
Reduces Hospital Stay and Recovery Time
The procedure itself takes one to three hours, the hospital stay is reduced to one to three days and the return to normal activities ranges from two to six weeks.
Recently surgeons at the CardioVascular Institute have been able to perform EVAR in many patients by direct puncture through the skin using ultrasound guidance, eliminating the need for any incisions at all. This further reduces the time to full recovery.
Frequent Follow-up Visits
Like any medical procedure, endovascular repair carries risks of complications. It also requires more frequent follow-up visits than open surgery, with regular imaging procedures, usually CT scans, needed to make sure the stent-graft is continuing to function properly.
Not all aortic aneurysms can be repaired by this method. Your vascular surgeon will help you decide which AAA treatment is best for you.