For AAAs at or above 5.5 cm (or special cases alluded to earlier) in patients fit enough to undergo intervention, the only treatment is surgery following detailed discussion with a Vascular Surgeon (with specialist interest in Aortic Aneurysm Surgery) to prevent further enlarging or rupture.
Broadly speaking, there are two surgical treatment options: Open Surgery, or Endo-Vascular Aneurysm Repair (EVAR).
Open surgery is performed under general anaesthetic. The abdomen is entered through an incision and the aorta is accessed in front of the spine. Clamps are applied to the normal aorta above and below the aneurysm. The aneurysm sac is opened, and a surgical graft made of Dacron fabric is sutured to the aorta above and below the diseased segment. After the procedure, the clamps are removed to allow the blood to flow through the graft and the aneurysm sac is oversewn.
In Endo-Vascular Aneurysm Repair (EVAR), an incision is made at the top of each leg exposing the arteries. A stent which is made up of a tube of fabric supported by metal struts is placed into the aorta under x-ray control. The stent is positioned so that its top and bottom ends are in healthy aorta above and below the aneurysm. Thereafter, the sheath housing this stent is withdrawn allowing the stent to spring into its open position. After the procedure the blood flows through the stent graft thereby excluding any flow in the aneurysm sac.
