AAA is the 13th leading cause of death in the nation, and the fifth leading cause of death in men over 70. An estimated 1.5 million people in the United States have it and 45,000 patients undergo surgical repair for it every year.

Aortic aneurysms occur when part of the aorta — the body''s main artery — weakens and enlarges up to two times its normal size. The most common site for this to occur is in the abdomen, between the breastbone and the belly button.

An Elusive Killer
AAA disease occurs most frequently in men age 60 and older who have a history of smoking, high blood pressure, high cholesterol, and heart and vascular disease. A family history of the disease is also a risk factor.

Unfortunately, AAA disease often goes undetected until the aneurysm actually ruptures. The chance of survival without surgery approaches zero, and even with immediate emergency surgery, survival is only 50 percent. But when an aneurysm is detected through imaging studies before it bursts, surgery can be done electively. Survival for patients who have this elective surgery at Barnes-Jewish Hospital is 98.2 percent, one of the best rates in the country.

A Proven Record of Success
Until the 1990s, the only way to repair AAA disease was through major surgery. Washington University School of Medicine (WUSM) vascular surgeons at Barnes-Jewish Hospital have participated in many clinical trials demonstrating excellent results of a much less invasive technique.

Currently, at Barnes-Jewish Hospital, more than 70 percent of patients with infrarenal aortic aneurysms (AAA) undergo endoluminal treatment with results that are much better than standard repair. This endovascular technique involves making small incisions (or percutaneously) in the groin to place a stent graft within the aneurysm. A metal stent anchors the graft inside the aneurysm.

Vascular surgeons at Barnes-Jewish Hospital have performed more than 800 infrarenal aortic repairs. This technique is frequently performed under spinal or local anesthesia, which allows a patient to go home within 24 hours of the procedure. On the other hand, with standard surgical repair, patients are hospitalized five to seven days and recuperate at home for up to two months.

This endovascular technique for aneurysm repair has been expanded to the thoracic aorta, where mortality and morbidity of open repair is significantly higher than open repair of abdominal aortic aneurysms. Barnes-Jewish Hospital has and continues to participate in three clinical trials of thoracic endograft repair with excellent results. Currently, vascular surgeons at Barnes-Jewish Hospital have performed more than 60 aneurysm repairs with this minimally invasive technique.