Abdominal Aortic Aneurysm Repair

What is a "triple A or AAA"?

Although most people think of AAA as an emergency road service, in the medical world, AAA stands for abdominal aortic aneurysm. It is often referred to as a "triple A."

An aneurysm is an enlarging or ballooning area which develops in a weakened area of the blood vessel. An aortic aneurysm occurs in the large blood vessel that comes out of the heart and provides blood to the rest of the body. The aorta goes from the chest to the abdomen. The aorta can balloon out in the abdomen, creating an abdominal aortic aneurysm. If the aorta balloons in the chest, it is called a thoracic aortic aneurysm (TAA).

Risk factors include:

• Age greater than 60
• High cholesterol
• Male gender
• Smoking
• High blood pressure
• Family history of aneurysms

Why does an abdominal aortic aneurysm need to be fixed?

An aneurysm usually starts as a small ballooning area. It can grow over time. As it grows, the vessel wall weakens. If it bursts, it can cause serious bleeding and lead to death.

If you have an aortic aneurysm, it's very important to know how big it is. The larger it gets, the higher the risk of bursting. Anything bigger than 5 cm is usually surgically repaired because of the high risk of rupturing. There are several different surgeries that can be done to repair an aortic aneurysm.

How is an abdominal aortic aneurysm repaired?

There are several ways to repair a large AAA.

Traditional surgery - a major operation - requires you to be put under major anesthesia. A large cut is made and a fabric tube called a graft is sewn to replace the ballooning vessel. This method has been used for over 50 years and has been very reliable.

Another method, which is less invasive, is to use an endovascular graft. After numbing the groin, a needle is placed into a large blood vessel. A flexible tube called a catheter is inserted. The endovascular graft is put into the catheter and carefully positioned. The graft is expanded and stays in place, fixing the problem. However, not all aneurysms can be repaired with surgery.

How long does the procedure take?

Traditional surgery is very long and takes several hours. The recovery takes weeks. You'll spend many days in the hospital.

With an endovascular graft, recovery is usually much faster. Many patients go home after a few days in the hospital.

What are the risks?

Traditional surgery has some risk of death, depending on the size of the AAA and the overall condition of the patient. Of course, the risk of death is even higher if the AAA is not fixed.

The endovascular graft process is safer than the traditional surgery. Bleeding and infection are possible at the incision. The risk of injury to other organs is very small. The risk of death is much smaller than with traditional surgery. However, the long-term benefits of this type of surgery are not yet known. You will need to have regular follow-up exams to monitor the graft because of this.

Sources:

American College of Surgeons

National Institutes of Health (NIH)

The Society of American Gastrointestinal and Endoscopic Surgeons

Society for Vascular Surgery

This article was reviewed and updated June 2007.