What is the Aorta?
The Aorta is the main artery which carries the blood from the heart to all the various parts of the body. It is the shape of a hockey-stick with the shorter end attached to the heart and the long end extending from the chest into the abdomen like a hose pipe giving off branches along its length to different organs. In the pelvis, it divides into 2 branches each going into one leg. At the base of the neck, it gives off the branches to the head and the arms.
What is an Aneurysm?
An aneurysm is a dilatation (expansion or distension) of a blood vessel. When the size of the blood vessel is increased to more than 2-2.5 times its normal diameter, it is said to be aneurysmal. The most common aneurysm that vascular surgeons treat is that of the abdominal aorta.
What is an Abdominal Aortic Aneurysm (AAA)?
This refers to aneurysmal dilatation in the abdominal portion of the aorta. The most common site of AAA occurrence is in the infrarenal portion of the abdominal aorta; that is to say, below where the branches to the kidneys come off. The normal diameter of the abdominal aorta is around 2 cm. Therefore, a measurement above 4 cm is considered aneurysmal.
What are the causes of an Abdominal Aortic Aneurysm (AAA)?
Abdominal aortic aneurysms are said to be multifactorial. There can be a number of courses which hand-in-hand can predispose a person to develop AAA. Here are some of the factors that can lead to AAA:
What are the symptoms of an Abdominal Aortic Aneurysm (AAA)?
In most cases an AAA are asymptomatic, and the patient is not aware of the condition. Often, they are demonstrated in radiological imaging performed for other reasons; for example, a CT scan performed look at the kidneys.
When should an Abdominal Aortic Aneurysm (AAA) be treated?
The decision to treat an AAA should be following a detailed discussion between the patient and their Vascular Surgeon. In most cases decision to treat is related to the size of the abdominal aorta and its aim is to prevent a rupture. Vascular Surgeons would agree that the threshold size at which treatment should be considered is 5.5 cm. However, there are some caveats:
Should I be screened for an Abdominal Aortic Aneurysm (AAA)?
In the UK, men who are resident in England receive an invitation in the post for screening for AAA on their 65th birthday*. Abdominal aortic aneurysms can be detected with an ultrasound scan which is a quick and painless investigation.
Any women or men under the age of 65 who are at risk (due to family history) can also be considered for screening.
What are the surgical treatments available for Abdominal Aortic Aneurysms (AAA)?
Once an AAA occurs, there are no medications or other cures that can reverse it. If the AAA has been discovered at a small size, there are some measures that can be instituted to prevent it from enlarging. This usually involves strict control of blood pressure and treatment of causative factors such as high cholesterol or smoking cessation. In some instances, this can delay or even stop the progression of the AAA.
What are the potential complications of surgery for Abdominal Aortic Aneurysms (AAA)?
The first and the most important complication which should be discussed with the patient is mortality. Its risk following open surgery is around 1-3% and following Endo-Vascular Aneurysm Repair (EVAR) <1%.
What is the recovery period after treatment of an Abdominal Aortic Aneurysm (AAA)?
Following surgery, patients require observation in the High Dependency Unit (HDU) or Intensive Care Unit (ICU) depending on the facilities available in the hospital and the requirements of the patient. This may take the first 72 hrs post surgery. Following that, the patients are usually stepped down to the surgical ward where they will stay until discharged.
Who should operate on an Abdominal Aortic Aneurysm and the type of facility where it should be done?
Only a Vascular Surgeon with expertise in both Open Surgery and Endo-Vascular Aneurysm Repair can offer bespoke advice on which treatment is best for a particular case.
The facility offering the treatment should have a reputation for treatment of Aortic conditions and have expertise in postoperative care in the High Dependency and Intensive care environments.