Treatment of AAA

What are the treatments for AAA?

Your general health as well as size and location of your AAA will determine how your aneurysm is treated. If surgery is not required, your doctor may recommend an ultrasound or computed tomography (CT) scan every 6-12 months to carefully monitor the aneurysms size and shape. Your doctor may also prescribe certain medications to help keep the aneurysm stable and, if you smoke, advise you to stop. If your doctor feels there is aneurysm rupture risk, surgical repair may be recommended. An AAA may be treated with either open surgical repair or by less invasive endovascular repair techniques.
 

Open surgical repair

Your surgeon will open your abdomen to gain access to your aorta, then implant a graft into the weak area of your aorta. Blood will flow through the graft inside your aorta instead of going through the aneurysm and this will prevent the aneurysm from enlarging further.
 
Open surgical repair
 

Endovascular repair

Endovascular repair of AAAs is much less invasive than open surgical repair. The procedure involves placing a wire reinforced fabric tube graft (called a stent graft) inside your diseased aorta. The new stent graft is placed within the vessel and protects the AAA from blood pressure stress. Through a small incisions in your groin, your physician will insert the stent graft parts over a guide wire. The graft is pushed through your femoral arteries and into the aneurysm by sliding along the wire. The stent graft is held in place through the use of metal hooks acting as anchors.

Endovascular repair

What are the possible risks of endovascular repair?

Not every patient is an endovascular repair candidate and there are possible complication risks. The risks and benefits of both the open surgical repair and endovascular repair procedures should be thoroughly discussed with your physician. Following your endovascular repair, it is important that you have regular scheduled follow-up appointments with your doctor. Most common complications can be identified early with a CT scan or X-ray.
 
Major risks associated with abdominal endovascular stent grafts include, but are not limited to:
  • Endoleaks— An endoleak is the leaking of blood around the graft into the aneurysm. Endoleaks can be detected using CT scans. Most endoleaks do not require treatment. Your doctor can decide if you need any treatment.
  • Stent graft movement— This is the movement of the stent graft from its original position over time. This can be assessed using imaging techniques like CT scans. Your doctor can decide if you need any treatment.
  • Device-related issues (for example, breaking sutures or the metal portion of the stent graft) —These issues may be detected using imaging techniques such as X- rays. Your doctor can decide if you need any treatment.
  • Endovascular devices require fluoroscopy and use of dyes for imaging. Patients with kidney problems may be at risk of kidney failure due to the use of dyes.
  • A hole or a tear of the blood vessels are risks associated with any catheter-based procedure.
  • Bowel complications including death of a portion of your bowel tissue requiring surgical removal.
  • Cramping pain and weakness in the legs and especially the calves.
  • Formation of blood clots that block the flow of blood to your organs.
  • Problems affecting your urinary and reproductive organs including infection and tissue death.

What are the benefits of endovascular repair?

There are a number of benefits to having an abdominal stent graft procedure versus undergoing open surgery. Some of these are listed below:
  • The procedure is minimally invasive.
  • The procedure can be performed under
    local anaesthesia.
  • There is a lower surgical complication rate.
  • The patient may lose less blood during the procedure.
  • This reduces the risk of blood transfusion.
  • The patient may spend less time in the intensive
    care unit after the procedure, and have a short
    hospital stay.
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