Abdominal aortic aneurysm repair is surgery to fix a bulge (ballooning), or aneurysm, in the aorta, the large artery that supplies blood to the abdomen, pelvis and legs. As the bulge grows, it weakens the walls of the artery, The aorta expands and contracts with each heartbeat putting the aneurysm under constant stress and increasing the potential of a rupture. A rupture in the aorta can be life threatening with symptoms of back and leg pain, dizziness, rapid heartbeat and shock. This complication is fatal in more than 20 percent of cases. If an aneurysm is causing no problems, it may be discovered with an ultrasound or CT scan that was done for another purpose.
Surgery is usually recommended if the aneurysm is five centimeters (two inches) or larger, or is growing at the rate of about a quarter inch in a six to 12 month period. The danger of an undiagnosed aneurysm is that it may break open suddenly requiring emergency repair surgery. Abdominal aortic aneurysm repair is also referred to as AAA repair, Triple A repair or abdominal aneurysmectomy.
Doctors use one of two procedures for abdominal aortic aneurysm repair.
Abdominal aortic aneurysm repair – open
The standard procedure for aneurysm repair involves cutting out the bulging section of the artery and replacing it with a tube made of synthetic material grafted at both ends to the artery.
Endovascular aortic aneurysm repair (EVAR)
In this newer, minimally invasive procedure, the surgeon uses x-rays to guide the insertion of a stent-graft, a metal coil in a synthetic tube, inside the aorta to the aneurysm. Small skin incisions are usually made in the groin for this procedure. Using a spring-loaded device, the surgeon opens the stent, which holds the graft in place to reinforce the walls of the aorta. The aneurysm eventually shrinks around the stent-graft.
Abdominal aortic aneurysm repair is performed under general anesthesia and/or using a regional epidural (spinal) anesthesia. It takes about two to four hours and recovery typically takes place in the hospital’s intensive care unit (ICU).
Upon discharge from the hospital, the doctor will provide instructions on activity, bathing and changing the dressing. Medication may be prescribed to manage pain or prevent blood clots from forming in the arteries and around the stent. Strenuous activity or lifting anything heavy must be avoided. Usually patients can take short walks or climbing stairs following open repair, but these tasks should be more limited with endovascular surgery. The doctor will advise when it is okay to resume driving and other activities.