Abdominal Aortic Aneurysm
The abdominal aorta is the main artery that carries blood directly from the heart through the abdomen. Branches of the abdominal aorta provide the blood supply to the organs in the abdomen including the kidneys and lower extremities. If the lining of the aorta is damaged or weakened, a bulge or aneurysm may occur. An abdominal aortic aneurysm (AAA) is dangerous because it can expand and possibly rupture. AAA is called a “silent” problem because it generally causes no symptoms. It is most often discovered during a routine medical exam. Once detected, AAA needs to be closely monitored to measure its size and follow its growth to determine if surgical repair is indicated. Abdominal aortic aneurysm may be treated with endovascular repair or open surgery. Both methods involve placing an artificial graft inside the damaged artery.
Endovascular Repair
In this procedure a graft made of wire mesh and fabric is placed inside the abdominal aorta through small incisions made in the groin. The graft takes pressure off the weak artery wall. Recovery time for this procedure is considerably shorter than open procedures, but not all patients are candidates for endovascular repair.
Two small incisions are made in the groin. A catheter or thin flexible tube is threaded through the artery at each incision site. The collapsed graft is placed inside one of the catheters.
The surgeon uses x-ray guidance to move the graft through the arteries toward the damaged part of the aorta. The catheters are used to place the graft in position.
Once the graft is in position, the surgeon expands it. Metal springs or hooks hold the graft in place above and below the aneurysm. The catheters are then removed, and groin incisions closed.
Open Surgery
With this method a single large incision is made in the abdomen and the graft is sewn into place above and below the aneurysm. Open surgery has a good long-term track record and may be the only alternative for some patients.
Surgery begins with an incision in your abdomen. The size and shape of your own incision may vary.
The surgeon gently moves aside the organs to reach the aorta. The aorta is clamped to stop blood flow. The surgeon then opens the aneurysm and clears any blood clot. The graft is sewn to the aorta above and below the site of the aneurysm.
Some of the aorta wall may be removed to allow for a snug fit when the aorta is wrapped around the flexible fabric graft. The aorta is then sewn together to protect the graft. Finally, the abdominal incision is closed.
