Abdominal aortic aneurysm (AAA) is a dilatation of the major blood artery in the abdomen that directs blood to the intestines, kidneys, liver and to the legs. Aneurysms, or enlarged arteries, can affect arteries throughout the body but tend to occur commonly in the lowest part of the aorta, just above the umbilicus (belly button). The normal aorta is about 2 centimeters (<1 inch). Due to weakness in the artery wall caused by smoking, hypertension or genetic predisposition, the aorta dilates over many years. Many famous people have had AAA including Albert Einstein, Charles DeGaulle and former Senator Bob Dole
Most AAA do not cause any symptoms, but are found on CT scan, ultrasound or MRI exams for unrelated reasons. This can be life-saving if they are found before they burst. When an AAA ruptures, the patient will typically have severe, constant back, side, or stomach pain. Although aneurysms of any size can burst, the risk increases significantly when the diameter exceeds 5 centimeters (2 inches). The chances of surviving a ruptured (burst) AAA are only 25-50%, even if you make it to the hospital. The goal is to repair the aorta before an aneurysm ruptures. Depending on a patient’s medical condition the chances of surviving an elective AAA repair are 95-98%.
Once the aorta is found to be greater than 3 centimeters (cm) we usually follow this with a yearly CT scan or ultrasound. Exams might be more frequent if the diameter approaches 5 cm. Treatment is generally recommended for good risk patients at 5 cm and 5.5 cm in patients with severe heart, lung or kidney problems. The treatment options include traditional, open surgery or endovascular repair. Open surgery involves replacing the aorta with a tube of artificial material, such as Dacron, through an incision in the abdomen or the flank (side). Endovascular aneurysm repair (EVAR) has only been FDA-approved since 1999. This technique involves placement of stent-supported graft through the groins, and is explained in greater detail in the section describing minimally invasive vascular surgery. The decision regarding open versus endovascular repair depends on a number of factors that must be discussed between the patient and all the treating physicians. At VSA we are skilled in both open and endovascular treatments and will choose the best option for each patient given their anatomy, health, and personal wishes. As part of the Cedars Sinai Aortic Center, we repair these aneurysms on a routine basis.