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Abdominal Aortic Aneurysm (AAA)

An abdominal aortic aneurysm (AAA) looks like a bulge in the aorta in the abdomen. Usually this disease is found near the end of the aorta below the arteries which bring blood to the kidneys. The wall of the aorta is weakened by this disease. The size of the bulge can is an indicator of how weak the aortic wall has become. If there is no treatment for a large aneurysm, it may continue to expand until it bursts (ruptures) – a life-threatening event.

Treating Abdominal Aortic Aneurysm

Studies have shown that for men, the benefits of treatment begin as the aneurysm approaches 5.5 cm (just over 2 inches) in diameter. For women, aneurysm repair usually is recommended when the aorta has ballooned to 5 cm. Other issues might affect these general guidelines, and a vascular surgeon will weigh all of these factors to find out if aneurysm repair is right for you. Small aneurysms can be safely watched by the vascular surgeon to see if there is progressive growth of the aorta.

If aneurysm treatment is needed, there are two types of procedure which can be used to repair the aneurysm: open aneurysm repair and endovascular aneurysm repair. A careful evaluation by a vascular surgeon experienced with all types of aneurysm repair is necessary to help choose the best procedure.

An open aneurysm repair has been used to treat aortic aneurysms for more than 50 years. It is performed through an incision in the abdomen or flank. The blood flow in the aneurysm is briefly stopped to allow for the repair. The aneurysm is opened and a fabric tube is sewn to the aorta above and below the aneurysm. Open surgery patients are typically hospitalized for five to seven days and then continue to heal at home for four to six weeks.

Some of the best results ever reported for open aortic aneurysm repair worldwide have come from the Heart & Vascular Center vascular surgeons. Our vascular surgeons have extensive experience treating the most common type of aneurysm (below the renal arteries).

At the same time, we are a national referral center for very complex aneurysms (in the upper abdomen or chest). We also routinely treat the rare aneurysms that involve the branches to the kidneys, intestines and liver, or spinal cord.The endovascular aneurysm repair has been developed more recently. By using special tools and techniques, surgeons can now repair an aneurysm from inside a blood vessel using x-ray images as guides. This endovascular technique has been pioneered and extensively used by Heart & Vascular Center surgeons. Special devices called endografts (large cloth-covered stents) are assembled inside the aorta under x-ray guidance and keep blood pressure from pushing on the weakened aneurysm wall. Unlike the larger incision needed for an open aneurysm repair, this minimally invasive technique requires only two small incisions in the groin. Because of the smaller incisions, most patients only require an overnight hospital stay and are usually released the day following the procedure. Patients can quickly resume their normal activities – most within two weeks. Heart & Vascular Center vascular surgeons are experts in performing less invasive repair of aneurysms and have performed more than 1,000 cases using this technique.

Digital image of a fenestrated stent repairing an abdominal aortic aneurysm
The first FDA-approved fenestrated endovascular abdominal aortic vascular graft for Phase II of the multicenter prospective trial was implantedin 2009 by Luis Sanchez, MD, and Patrick Geraghty, MD.

Not everyone can be treated with an endovascular aneurysm repair because of the shape of the aneurysm or other blood vessels. The vascular surgeons at the Heart & Vascular Center are using the latest techniques to increase the numbers of patients who can be treated with the endovascular technique.

The Washington University and Barnes-Jewish Heart & Vascular Center is one of 10 centers in the nation testing new “fenestrated stents” in a clinical trial. These stents are offering hope for patients whose abdominal aortic aneurysm is too close to the arteries that feed the kidneys. For these patients, stent placement has not been an option because the stent itself would block blood flow to the kidneys. A fenestrated stent features small openings (fenestrations) that can be strategically positioned to allow blood to pass into the renal arteries. The stents are custom-made for each patient, based on precise images and measurements taken by our surgeons and clinical trial investigators.

Survival for patients undergoing AAA repair at the hospital is 99 percent, one of the best survival rates in the country. Because of the experience and track-record, physicians throughout the region refer most complex AAA cases to the vascular surgeons at the Heart & Vascular Center. Our vascular surgeons have access to many advanced devices, as well as extensive experience using complex endovascular techniques not available in most medical centers. We train surgeons from around the region and around the world.

Vascular surgeons at the Heart & Vascular Center carefully review each case. The physicians take the time to listen to their patients and help them to understand all the risks and benefits of treatment. If appropriate, patients may participate in studies offering access to the latest developments in endograft technology. Even if patients have been evaluated elsewhere previously, they are welcome to see the vascular surgeons at the Heart & Vascular Center for a second opinion on treatment options and to learn more about the advantages of being cared for by internationally recognized experts in vascular surgery.

To make an appointment with a Washington University heart or vascular specialist at Barnes-Jewish Hospital, call 855.925.0631.