heart and blood vessel disorders
Abdominal Aortic Aneurysms
Treatment of Abdominal Aortic Aneurysms
A procedure to replace the aneurysm with a synthetic graft Abdominal aortic aneurysms that are less than 2 inches (5 centimeters) wide rarely rupture. The only treatments required may be Medications for Treatment of High Blood Pressure to lower blood pressure, statins to lower cholesterol, Imaging procedures are done to estimate the rate of enlargement and determine when repair will be necessary. At first, procedures are done every 3 to 6 months, then at various intervals, depending on how quickly the aneurysm is enlarging. Aneurysms that are wider than about 2 to 2½ inches (5 to 5.5 centimeters) may rupture, so doctors usually recommend repair, unless repair is too risky for a particular person. In people with Marfan Syndrome , aneurysms are at a higher risk of rupturing at narrower diameters, and so an aneurysm may be repaired earlier, when its diameter at the aortic root (part of the aorta nearest the heart) is about 1½ inches (4.5 cm) wide. A person can live with a small abdominal aortic aneurysm, but doctors recommend treatment once the aneurysm reaches a certain size. Repair consists of inserting a synthetic tube (graft) to replace the aneurysm. There are two approaches: Traditional surgery Endovascular stent graft repair Withtraditional surgery,a general anesthetic is given, and an incision is made from below the breastbone to just below the navel. The graft is stitched into place in the aorta, the walls of the aneurysm are wrapped around the graft, and the incision is closed. This procedure takes 3 to 6 hours, and the hospital stay is usually 5 to 8 days. The risk of death during surgery to insert a graft is about 2 to 5% but can be higher if a person has other serious medical conditions. Endovascular stent graft repairis a less invasive approach that is used in more often than traditional surgery. A regional (epidural) anesthetic, which causes loss of sensation only from the waist down without loss of consciousness, is used. Through a special puncture needle, a long, thin guide wire is threaded through the femoral artery into the aorta to the aneurysm. A tube (catheter) containing the stent graft (which resembles a meshed, collapsible straw) is guided over the wire and positioned inside the aneurysm. Then the stent graft is opened, forming a stable channel for blood flow. This procedure takes 2 to 5 hours, and the hospital stay is usually 1 to 2 days. The choice of aneurysm repair technique depends on many factors, including the person's age and general health and the anatomy of the aorta and the aneurysm. In general, open surgery may be used for younger and healthier people because the results may last longer in patients who are expected to live at least 10 years. The endovascular stent grafting procedure is used for older people or for people who are in poor health and who might not survive an open surgical procedure. Rupture or impending rupture of an abdominal aortic aneurysm requires emergency open surgery or placement of an endovascular stent graft. The risk of death during an emergency repair of a ruptured aneurysm is about 50%. The risk of death may be lower (20 to 30%) with endovascular stent graft placement. When an aneurysm ruptures, the kidneys may be affected because their blood supply is disrupted or because blood loss results in Shock . If kidney failure develops after repair of a ruptured aneurysm, the chances of survival are very poor. 