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Cape Cod Abdominal Aortic Aneurysms:  what to do?

Abdominal Aneurysm is a ballooning out of the walls of the aorta, The main blood vessel going from your heart to your abdominal organs and legs and carrying about 80% of all blood flow, the aorta has significant pressure inside it, your blood pressure or 120-150mm of mercury or about 3 or 4 psi, similar to a partially deflated bicycle tire.

Even this relatively low pressure by tire standards can, over time, cause ballooning of the walls of the aorta.  Just like the bubble you can get on your tire after you hit the sharp granite curbing, weakening of the aorta can occur due to cholesterol deposits in the aortic walls. The combination of the high pressure and weak walls can lead to ballooning and eventual rupture of the aorta. This process takes many years to go from a normal aorta of about 1 inch in diameter to one that is ready to burst at around 2 1/2 to 3 inches. If it blows, you are unlikely to survive due to massive internal bleeding and death within minutes. The trick is to identify early enlargement and act responsibly.

Who is at risk for this? Men (more than women), over 55 years, overweight, smoker or prior smoker with high blood pressure is the highest risk group. Although AAA can be felt with a thorough physical exam, it is notoriously hard to feel a 3 inch bubble under a layer of fat in overweight people. Furthermore, there are rarely symptoms even from large aneurysms although when they are ready to burst, there may be a few days of mid back pain. AAA runs in families with significantly increased incidence in people who have close relatives with aneurysms. Fortunately, ultrasound screening is virtually 100% effective at making a diagnosis and is used to follow small aneurysms to be sure they are not growing dangerously large.  See our website for ultrasound availability.

AAA treatment
If you are diagnosed with an aortic aneurysm you should most importantly follow it closely to see if it is enlarging. If the aneurysm is small, less than 1 1/4 inches or about 3 cm it can be followed annually because it is unlikely to grow quickly. It may remain like this for years especially if the underlying problems of high cholesterol and high blood pressure are controlled and smoking ceases.  Once the aneurysm gets bigger than 4 cm or about 1 3/4 inches it is increasingly likely to grow more quickly and steadily and should be followed more frequently.  Generally repair is considered when the aneurysm reaches about 2 inches or 5 cm.  By then the wall is stretched so thin that rupture becomes unpredictable.

Repair can be the tried and true way, to open the abdomen and wrap a Dacron mesh, that looks like fiberglass matting around the aneurysm after cutting it open and removing the weakest segment. This is a big operation with a significant risk of death or disability (1-8% death rate depending on the health of the patient) but is pretty much a permanent fix.  The newer alternative is to place a ‘stent-graft’ inside the blood vessel by threading it up into the aneurysm through a blood vessel in the groin.  A ‘stent graft’ looks like a slinky with a cloth (again, Dacron) covering. It can be stretched so it is thin enough to go through the smaller groin artery then unfolded in the aorta and attached to the inside of the aorta at the top and bottom. It is a procedure that takes a few hours and people can be out of the hospital the next day. It may be the only way to fix the aorta for those in too sick to undergo the very stressful open procedure. The downsides are that there is a small chance of failure to seal off the aorta at the top and bottom initially and subsequent leaks can occur as the aorta itself continues to weaken over time so close followup indefinitely is needed. All this means you will become very friendly with your vascular surgeon so choose wisely.

You can check out our complete vascular surgical team on our website.

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Cape Cod
Posted by Cape Cod - (website) on 06/25/08
Categories: Life
Keywords: aortic aneurysm, vascular, cardiac


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