Title: Small Abdominal Aortic Aneurysms: endovascular repair or surveillance?
Name: Joe MacDonald, MS3
Summary:
What is an Abdominal Aortic Aneurysm?
The aorta is a large vessel that carries blood away from your heart. The aorta first
runs through the chest. After reaching the abdomen it is
called the abdominal aorta. The abdominal aorta carries
blood to your lower body.
An aneurysm is a bulging of a blood vessel wall. It
is usually a weak area that swells like a balloon.
Aneurysms can occur in many blood vessels including the
aorta. We refer to aneurysms of the abdominal aorta as
abdominal aortic aneurysms, or AAAs. Small AAAs are
between 4 cm and 5 cm in diameter.
AAAs that are not growing or ruptured usually
have no symptoms. Many AAAs are found by screening or
incidentally. The symptoms you may have with a AAA are
severe pain, racing heart, lightheadedness, nausea, and
vomiting. A rare symptom is pain and discoloration of the
feet. If rupture occurs you may rapidly start having the
symptoms. Rupture requires immediate medical attention.
What are Treatment Options?
1) Surveillance
Scheduled imaging to assess size and growth. Option 2 or 3 may be needed if the
aneurysm grows large or quickly.
2) Open Surgical Repair
A large cut in the belly lets the surgeon reach the aorta. The surgeon then
replaces the aneurysm with a plastic tube. This tube carries the blood
that the aneurysm did before. With the blood flowing through the tube
there is less pressure on the aneurysm. This lower pressure decreases the
risk of rupture.
Figure 0: Open Surgical Repair
3) Endovascular Stent Graft (EVAR)
The surgeon makes small cuts near your hips. Through these small cuts
a stent is passed inside the blood vessels to the aneurysm. The stent is
similar to a plastic tube. The surgeon anchors the stent across the
aneurysm. Once in place the stent supports the vessel. This extra
support reduces the chance of rupture.
Which Option is Best?
AAAs between 4 and 5 cm are considered low risk. Prior to the
development of EVAR the standard was surveillance. EVAR is now a very
safe surgery. The increase in safety has led to reconsideration of
Figure 0: EVAR after placement
EVAR as an option for small AAAs. The early results of a large
study comparing surveillance and EVAR for small AAAs has
shown no major difference in outcomes. These are only early results, but suggest early
EVAR may benefit some patients with small AAAs.
The risks and benefits of EVAR vary with each patient. Your doctor will go over
the many factors to consider in making this decision. Some to consider are:
1) Your age and other medical conditions
2) The size and growth rate of the aneurysm
3) The chance you will follow through with suggested surveillance
Additional Resources:
http://familydoctor.org/online/famdocen/home/articles/883.html
http://www.nlm.nih.gov/medlineplus/tutorials/abdominalaorticaneurysm/vs049103.pdf
Key Words:
Abdominal Aortic Aneurysm
Endovascular Repair
Abdominal Aortic Aneurysm Surveillance
Small AAA Management
Asymptomatic AAA
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