Abdominal Aortic Aneurysm-treatable but underdiagnosed vascular disorder

Abdominal Aortic Aneurysm (AAA) is an abnormal enlargement of the aorta at a level below the blood vessels to the kidneys or renal arteries. AAA are generally without symptoms, or asymptomatic, until it arises to a size where its associated with abdominal or back pain. These symptoms arise from stretching of the sensory nerves within the wall of the enlarging aorta. As a general comment, a symptomatic aneurysm suggest impending rupture and merits immediate medical evaluation which frequently leads to surgery.

Unfortunately, because the aorta is located in the retroperitoneum , the blood vessel frequently reaches a large size when it remains asymptomatic. AAA that rupture are associated with an 80-90% out of hospital mortality. A patient who survives to make it to the hospital and to the operating room has a 50% mortality within 30 dys operation. This mortality is a reflection of the risk of heart attack, stroke, pulmonary infection, and renal failure.

Risk factors associated with AAA formation include a 20:1 M:Fdistribution, more common in Caucasians, non diabetics, smokers and first degree relatives (regardless of gender) of patients who have an AAA.

To this end, early diagnosis permits monitoring and planning for repair of the AAA when it reaches a threshold of 5.5cm. The rationale is that the risk of rupture before a patient reaches this threshold is quite low (but not zero). In a scenario of a patient with a AAA< 5.0 centimeters the aneurysm is usually monitored at 6-12 month intervals with US or CT imaging.

Currently 70% of AAA can be treated with a minimally invasive device called an aortic stent graft. This allows the aneurysm to be treated via small groin or puncture site. This approach is in comparison to the Open repair of an aneurysm. Open repair first done in the early 1950's is performed through a midline incision from the ribcage down to the bladder area.


The minimally invasive procedure or (EVAR) is associated with shorter lengths of hospitalization, decreased blood loss and high patient satisfaction. Improvements in technology have resulted in a greater number of abdominal aneurysms that can be treated with EVAR.  The drawback with EVAR is that 20-30%, will develop a secondary intervention that requires a secondary revision. Most revisions can be done via an endovascular route. However, a subpopulation of patients will require open repair of their AAA with explantation of the stent graft.

If you or your family member have been diagnosed with a AAA, seek an opinion on management options from a Board Certified Vascular surgeon