What Is An Abdominal Aortic Aneurysm (AAA)?

If an artery weakens it will sometimes bulge out and expand. This enlarged area is called an aneurysm. The most common site is in the abdominal aorta, the large artery that carries blood from the heart through the abdomen to the legs. Such an aneurysm is called an abdominal aortic aneurysm, more commonly referred to as an AAA or "Triple A". Aneurysms less commonly occur in the branches of the aorta that go to the legs (the iliac arteries) and in the legs themselves where they enlarge the popliteal artery behind the knee.

What is the significance of an Abdominal Aortic Aneurysm?

Abdominal Aortic Aneurysm

The main risk of an aneurysm is that it can rupture resulting in profuse bleeding and often death. AAA causes more than 10,000 deaths in the USA and many of these are preventable through early diagnosis and treatment. Approximately 50,000 patients undergo surgery for AAA in the USA alone every year. Once the AAA has ruptured, the chance of dying is 80-90% therefore there are clear-cut reasons for screening for this problem.

Who is at risk for AAA?

After the age of 65 a man has a risk of approximately 7%, whereas it less than 1% for a woman. By the age of 80 the risk is up to 10% for a male vs. 2% for a woman. A person’s risk is also increased if a family member had an AAA.

Smokers, patients with atherosclerosis "hardening of the arteries", heart disease, and COPD/emphysema have the highest risk.

How are AAA's diagnosed?

Unfortunately, aneurysms frequently produce no symptoms before they leak or rupture that would prompt a person to seek medical attention. But they can be picked up at a regular physical examination. When an examining doctor discovers signs suspicious of an abdominal aneurysm, an ultrasound examination may reveal its size and location. More advanced tests, like a CT scan and M.R.I., are usually included in the diagnostic workup.

Medicare will pay for AAA screening via the SAAAVE act. To be eligible, you must be a male who has smoked in your lifetime or be a male or female with a family history of AAA.

What is the treatment for AAA?

There is no medical treatment for aneurysms. In general people with small aneurysms are encouraged to control blood pressure and treat conditions that may accelerate atherosclerosis. Smoking must be stopped if possible. Exercise is not restricted. Once the AAA has reached a certain size threshold putting patients at risk for the AAA rupturing, the AAA should be repaired via a surgical procedure:

Dr. Vinit Varu champions an endovascular repair, or EVAR. In this new, less invasive technique, a catheter is inserted into the arteries through a small incision in the groin. Under x-ray guidance, a vascular endograft is delivered through the catheter and placed inside the aneurysm. This endografts fits snugly into the normal artery above and below the aneurysm and so forms a new pathway for the blood to flow thus excluding the aneurysm sac, which then usually goes on to shrink. Patients go home the next day and frequently are able to resume normal activity by one week. Most patients are suitable for this minimally invasive technique, but all patients must undergo a CT scan to ensure this technique is feasible.

Less commonly an open surgical repair is needed.

Abdominal Aortic Aneurysm before repair

AAA before repair

Endovascular aneurysm repair (EVAR)

Endovascular aneurysm repair (EVAR)

Successful exclusion of AAA following EVAR

Successful exclusion of AAA following EVAR

Follow up CT scan showing successful repair

Follow up CT scan showing successful repair

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