Dr Abhishek Mohanty | All you need to know about Abdominal Aortic Aneurysm | Continental Hospitals

29/11/2021

What Is An Abdominal Aortic Aneurysm (AAA) ?

An abdominal aortic aneurysm is an enlarged area in the lower part of the major vessel that supplies blood to the body (aorta). The aorta runs from the heart through the center of the chest and abdomen.

The aorta is the largest blood vessel in the body, so a ruptured abdominal aortic aneurysm can cause life-threatening bleeding.

Depending on the size of the aneurysm and how fast it's growing, treatment varies from watchful waiting to emergency surgery.

Symptoms

Abdominal aortic aneurysms are often silent killers which grow without any noticeable symptoms. Some aneurysms stay small or never rupture ,whereas others grow larger over time, sometimes quickly.

If you have an enlarging abdominal aortic aneurysm, you might notice:

  • Deep, constant pain in the belly area or side of the belly (abdomen)
  • Back pain
  • A pulsatile sensation in abdomen

In complex cases , they may present with loss of weight and appetite , vomiting after eating , renal failure , pain in either of both legs while walking etc.

Work Up:

Ultrasound of abdomen is a used initially for screening such patients . CT AORTOGRAM is used for confirmation and planning for treatment.

Who needs screening for detection of AAA?

  • Men ages 65 to 75 who have ever smoked cigarettes should have a one-time screening using abdominal ultrasound.
  • For men ages 65 to 75 who have never smoked, a doctor will decide on the need for an abdominal ultrasound based on other risk factors, such as a family history of aneurysm.

Treatment for Enlarging AAA ?

Endovascular repair is a preferred treatment for many people with an abdominal aortic aneurysm (AAA), and an alternative for some who do not qualify for open surgery.

In endovascular repair, doctors attach a synthetic graft to the end of a thin tube (catheter) that's inserted through an artery in your leg and threaded up into your aorta. The graft — a woven tube covered by a metal mesh support — is placed at the site of the aneurysm and fastened in place with small hooks or pins. The graft reinforces the weakened section of the aorta to prevent rupture of the aneurysm. Once in place, blood flows through the stent graft and cannot enter the aneurysm.

The procedure usually takes 1.5–2.5 hours and most patients leave the hospital in 1–5 days.

Some aneurysms have complex shapes affecting one or more of the important arteries that branch off the aorta. They need a special type of graft known as a ‘fenestrated graft’ . The procedure usually takes from 3-8 hours

Stent graft used for AAA repair

 

Case history:

A 57 year gentleman presented to us with complaints of dull aching pains in lower abdomen and pain in right leg while walking.

After Ultrasound abdomen, an Abdominal Aortic Aneurysm was suspected. CT aortogram was done to confirm the diagnosis. It revealed a large abdominal aortic aneurysm with a diameter of 5.1 cm. Si After discussing the treatment options , the patient consented for a minimally invasive procedure called EVAR ( EndoVascular Aortic aneurysm Repair) .

EVAR was done successfully without any complications. The procedure took 1.5 hours to complete. He was monitored overnight in ICU.

He was discharged from the hospital after 2 days.

This is one of the many case that we have been doing since last few years. We run a dedicated ‘Aortic Clinic’ for screening and managing such group of patients .

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