Expert diagnosis and treatments for AAA
When an artery weakens, it can sometimes bulge out and expand in any area of the body as an aneurysm. The most common site is in the abdominal aorta, the large artery that carries blood from the heart through the abdomen to the legs. This is commonly called AAA or Triple A.
Aneurysms in the abdominal area enlarge slowly over years of time. Unfortunately, aneurysms frequently produce no symptoms before they leak or rupture. But they can be discovered during a regular physical examination. For example, an abdominal aneurysm often feels like a tender, throbbing lump under the skin and the patient or an examining doctor may discover the pulsating mass. Even if the lump cannot be felt, the doctor can often hear suspicious sounds of turbulent blood flow through a stethoscope on the abdomen.
When an examining doctor at DVVI discovers signs suspicious of an abdominal aneurysm, a Doppler Duplex Ultrasound examination –– which is a simple, quick, non-invasive test –– may reveal its exact size and location, especially for people at high risk of AAA. More advanced tests, like a CT scan and M.R.I., are usually included in the diagnostic workup. Once an aneurysm has been diagnosed, an arteriogram (angiogram) may be required to plan treatment.
- Are smokers
- Have circulation problems in your legs
- Have emphysema
- Have heart disease, particularly coronary disease, previous heart attacks or a heart bypass
- Have carotid artery disease or a prior stroke, ministroke or TIA
- Have high blood pressure.
There is not much benefit for surgical intervention for aneurysms under five centimeters. Once the aneurysm reaches 5cm, however, the risk of rupture may approximate 10% per year. Under such circumstances, most surgeons would advise repair of the aneurysm unless the patient has prohibitive medical risks against treatment. Although the endovascular treatment is safer than standard surgery, most surgeons would still favor withholding this treatment until the aneurysm reaches 5cm.
There is no medical treatment for aneurysms. In general, people with small aneurysms are encouraged to control their blood pressure and treat conditions that may accelerate atherosclerosis. Smoking must be curtailed or stopped entirely. Exercise is not restricted. There is some experimental work being performed to see whether drugs such as beta-blockers or some antibiotics may slow AAA growth, but as yet results have not been encouraging.
At DVVI, we prefer minimally invasive endovascular repair whenever it’s an option versus open surgical repair surgery. In this newer technique, a catheter, or small tube, is inserted into your arteries through a small incision in the groin. Under x-ray guidance, a vascular endograft is delivered through the catheter and placed inside the aneurysm. This endograft fits snugly into the normal artery above and below the aneurysm so that it forms a new pathway for the blood to flow. This excludes the aneurysm sac, which then usually begins to shrink.
Patients go home the next day and are frequently able to resume normal activity by one week. It is expected that mortality will be less than that for standard surgery, but as yet this has not been conclusively proven. Complications such as gangrene of the leg, claudication, kidney failure, need for colostomy, pneumonia, paralysis and heart attack can also occur with this procedure; however, sexual dysfunction should not occur.
Unfortunately, not all patients are candidates for this type of procedure. Your DVVI vascular surgeon must evaluate each patient on a case-by-case basis and approximately 10% of patients may require a further procedure at some stage in the future to fix problems that may develop over time with the graft or the aneurysm sac.
Normally, these procedures can be performed as an outpatient. Because this is a new procedure, long-term surveillance of the patient must be performed, usually by means of a CAT scan or an ultrasound test. A few patients have ruptured the AAA despite an apparently successful procedure.
Call us now to learn more or to schedule a consultation: (760) 568-3461