Last time, in Part 2 of our three part series, we promised to talk about treatment for and Abdominal Aortic Aneurysm (AAA) greater than 5 cm in diameter. As you recall, this dilation is a weak area (aneurysm) on the blood vessel whose risk of rupture goes progressively higher with increasing diameter. Since the risk of rupture of an AAA of 5cm or greater averages 10%/year or higher and the open repair of AAA has a 5-6% mortality rate, it makes sense to repair AAAs greater than 5cm in diameter.
The Link Between AAA and Your Cardiac Health
If you have one of these big aneurysms, the first thing to do is to be evaluated by a Vascular Surgeon skilled in the repair of this condition. One of the important things the surgeon will do is evaluate your cardiac risk. There is a strong association between AAA and coronary artery disease (blockage in the vessels that supply the heart muscle). This association is so strong that if overlooked, coronary artery disease (CAD) becomes the leading cause of mortality and morbidity associated with repair of AAA.
This link makes pre-operative cardiac evaluation mandatory unless:
1) the patient is asymptomatic and had coronary artery bypass surgery within the last 5 years or
2) the patient is asymptomatic and has had cardiac clearance within the last 2 years.
If the patient has significant CAD, then this problem should be attended to first. Many lives have been saved by performing open heart surgery or angioplasty before working on the abdominal aortic aneurysm when significant coronary artery disease is found. Assuming that the cardiac evaluation is negative, and there are no other serious medical contraindications, surgical repair for the AAA can be considered.
Surgical Repair Options for an AAA
Open surgical repair has been around for a long time. Dubost, a French surgeon, performed the 1st open resection and repair of AAA back in 1951. It is a good operation that has stood the test of time. The AAA is resected and a Dacron graft is inserted to replace the diseased aneurysmal segment. Under the best of conditions the patient is in the hospital for about 1 week. There is significant pain for there are usually 1-3 incisions, the abdominal one traversing the entire length of the abdomen. The patient cannot eat for several days and once home it takes about 6 weeks for full recovery.
Beginning in the late 90’s, there has been a paradigm shift in the field of Vascular Surgery. Many of the techniques taught to Vascular Surgeons in their training programs can now be done differently. Open repair of AAA is one of them. Nowadays it is possible for the surgeon to insert the graft endovascularly (from within the vessel).
In the "new" type of open repair, two 8-10cm incisions, one in each groin, are used to expose large arteries there. Using X-ray guidance, the graft can be inserted up into the aorta and the aneurysm is excluded. The patients can eat as soon as the anesthetic wears off. The pain is much less since often there is no abdominal incision. The patients go home the next day and the recovery time is relatively brief. Also, the morbidity and mortality rates are less than with the original type of open repair. The bad news is that not all patients are candidates for this “new” repair. Your Vascular Surgeon should be able to tell you whether you are a candidate or not.
AAAs are not to be taken lightly. Screening exams and consulting a Vascular Surgeon are the best ways to stay out of trouble with this problem.
Contact Five Star Vein Institute to schedule your free vein screening with Dr. Robert Ruess and his staff. Find out if you are at risk for any venous disease and what your treatment options include.