Abdominal Aortic Aneurysm Repair

An aortic aneurysm occurs when there is an abnormal bulge in the wall of the aorta, the largest artery in the body that delivers oxygen-rich blood from the heart to the rest of the body. Approximately 15,000 people in the United States die of a ruptured aortic aneurysm every year. Detecting aortic aneurysms can be difficult because they usually grow slowly and do not cause any symptoms.

Certain people are at higher risk for developing an aortic aneurysm. The condition tends to occur more often in people who smoke, have high blood pressure, are Caucasian males over the age of 60, suffer from atherosclerosis (buildup of plaque in the arteries), or have a family history of aortic aneurysm. Additional factors that can contribute to the development of an aortic aneurysm include Marfan syndrome (a genetic connective tissue condition), other connective tissue diseases, problems with valves in the heart, previous aortic injury, and traumatic injury from falls or motor vehicle crashes.

Detection of an aortic aneurysm usually occurs during a routine medical test, such as a chest X-ray or ultrasound, which may be ordered for another reason. An echocardiogram, computerized tomography scan, or magnetic resonance angiography test may be done to confirm the diagnosis. Aortic aneurysms can be categorized by shape, location, and how they are formed. Aortic aneurysms can form as a symmetrical bulge on the aorta or as a small, asymmetrical blister on the side of the aorta. Approximately 75 percent of aortic aneurysms are located along a portion of the aorta that passes through the abdomen. Most aneurysms occur because of a breakdown in the connective tissue and muscular layer of the aorta due to smoking, high blood pressure or genetic conditions.

Treatment for an aortic aneurysm depends on its size, location and the patient’s general health. If the aneurysm is small (less than two inches in diameter) and does not cause any symptoms, regularly scheduled checkups and imaging tests may be recommended to monitor the size of the aneurysm. Medications can be prescribed to lower blood pressure and cholesterol and reduce the risk of complications from the aneurysm.

Surgery may be the treatment of choice if the aneurysm is larger or growing more than .4 inches per year. Open chest or abdominal surgery involves removing the damaged section of the aorta and replacing it with an artificial graft that is sewn in place. Endovascular surgery also can be performed to repair a damaged aortic artery. This procedure requires inserting a catheter with an attached graft (a metal mesh support that covers a woven tube) through an artery in the leg. The catheter is threaded to the weak part of the aorta and the graft is positioned and expanded to reinforce the aortic wall and prevent rupture of the aneurysm.

People who have been diagnosed with an aortic aneurysm should keep their blood vessels as healthy as possible by not smoking, eating a healthy diet, controlling blood pressure, exercising regularly, and reducing fat and cholesterol in their diet. For more information about aortic aneurysms, talk with your doctor or visit the Society of Thoracic Surgeons website at www.sts.org.

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