The majority of aortic aneurysms are abdominal aortic aneurysms. While small abdominal aortic aneurysms rarely rupture, they can grow very large without causing symptoms.
The typical size of an abdominal aorta is 2 to 3 centimeters: about the size of a quarter. An enlarged abdominal aorta is typically greater than 3 centimeters. All patients with an enlarged aorta who do not meet surgical criteria need regular surveillance and monitoring. This may include testing by CT scan or ultrasound imaging.
Although the exact cause of aortic aneurysms is unclear, risk factors such as smoking, in conjunction with diseases such as hypertension, increase the probability of developing the condition.
An abdominal aortic aneurysm typically produces no symptoms, but as the size of the aneurysm increases, abdominal and/or back pain may develop. Other symptoms may include pain radiating to the groin and a pulsating mass in the abdomen.
Abdominal aortic aneurysms are often diagnosed as an incidental finding on an imaging study performed for some other reason. If an abdominal aortic aneurysm is suspected, testing may include:
- Abdominal ultrasound: Sound wave technology helps assess the aorta.
- Computerized tomography (CT) scan: Provides clear images of the aorta and detects the size and shape of an aneurysm.
- Magnetic resonance imaging (MRI): Imaging procedure to diagnose an aneurysm and determine its size and location.
In deciding whether to recommend AAA repair, a surgeon will typically consider the size of the aneurysm, its location, how fast it is growing, how complicated it is to repair and the patient’s overall health. Treatment options include open surgical repair and minimally invasive endovascular repair.
Open Surgical Repair of AAA
Open surgery remains the standard treatment for AAA repair. The surgery involves an abdominal incision to gain access to aneurysm. The aneurysm is opened and a graft, typically made of Dacron™ or Gore-tex™, is sutured into the proximal and distal ends of the aorta and fixed into place. The dilated portion of the aorta is then closed over the graft.
Minimally Invasive Repair of AAA
Approximately 70 percent of patients are candidates for endovascular aneurysm repair (EVAR), a minimally invasive procedure to repair an AAA. The procedure requires a small incision in the groin (to insert a catheter), followed by the placement of a stent graft inside the aneurysm to reinforce weak spots in the artery. This procedure is very effective in preventing aneurysm rupture, shortens the hospital stay and greatly reduces major complications.
For those who don’t qualify for EVAR, a fenestrated endograft (FEVAR) is another minimally invasive option for treating an AAA. The fenestrated endograft is inserted into the femoral artery through a groin incision, then guided through the blood vessel to the aneurysm.
AAA Treatment at University of Michigan Health
The Comprehensive Aortic Program at the Frankel Cardiovascular Center is one of the highest volume centers for abdominal aortic aneurysm in Michigan. With nine physicians dedicated to providing the highest quality of care for abdominal aortic aneurysms, our multidisciplinary program brings together a team of specialists to review complex cases and create the best treatment plan for each patient.
Our experts can manage complex aortic disease including abdominal aortic aneurysm and all conditions associated with it, including:
- Aortic infection
- Penetrating ulcer with pseudoaneurysm (false aneurysm)
- Post-traumatic aneurysm
- Small aneurysms that thrombose (aortic occlusion)
Not all patients with abdominal aortic aneurysms require immediate surgical treatment. We can provide comprehensive care and monitor the progressions of these aneurysms until surgery becomes necessary.
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