Treatment Options

Once a patient has been diagnosed with an aneurysm, the physician will normally suggest that a CT scan be performed. The CT scan will help the physician characterize the aneurysm. Aneurysms under 4-5 cm in diameter are usually monitored with regularly scheduled CT scans. The risks associated with surgery are greater than the risk of having the aneurysm rupture. This is commonly referred to as "watchful waiting". Once the aneurysm increases in size, or demonstrates rapid growth the risks of rupture outweigh the risks of surgery.

There are currently two methods of treatment for AAAs. One is an open surgical repair, which is the most common but also the most invasive treatment. A minimally invasive alternative to open surgery is endovascular AAA repair, which utilizes stent grafts.

The open surgical repair of a AAA is performed under general anesthesia by a vascular surgeon. The procedure requires an incision initiating below the sternum and extending to the navel so that the internal abdominal organs, chiefly the intestine, can be moved aside to access the aneurysm. Once exposed, the aorta is clamped above and below the aneurysmal sac. The aneurysm is incised and a prosthetic graft is sutured in place. The clamps are then removed and blood flow resumes through the prosthesis. The intestines are put back into place and the incision closed. The procedure is typically completed within four to six hours. The patient usually requires a few days in the Surgical Intensive Care Unit (SICU), and the total hospital stay may be 8-14 days. Post procedure convalescence may take 4-6 weeks due to the invasiveness of the operation.

Endovascular Repair:

Endovascular AAA repair entails the insertion of a compressed stent graft contained within a catheter. The stent graft can be anchored to the aorta providing a conduit for blood flow and shunting it away from the weakened portion of the aorta. The stent graft may or may not be supported by a scaffolding cage and there can be any number of ways to deploy the specific endoluminal graft (ELG). The insertion requires only one or two small incisions in the artery of the legs and eliminates the need to perform an abdominal incision. Most clinical studies to date have reported reduced hospitalization time, as well as reduced complications with the use of ELG's in appropriately selected patients.

Patients are often discharged the day after endovascular repair. Once discharged, most patients return to normal activity within 2 weeks compared to 6-8 weeks after open surgical repair. If you are interested in learning more about this procedure, please contact your physician.

Refer to A Patients Guide to Minimally Invasive Abdominal Aortic Aneurysm Repair on the Patients page of this website for information on the risks and benefits of endovascular repair.

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