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Abdominal Aortic Aneurysm Screening and Repair
What is Abdominal Aortic Aneurysm Screening and Repair?
What is Abdominal Aortic Aneurysm?
An aneurysm is a weak section of an artery wall. These can occur in any portion of the aorta, but the abdomen is the most common location. An Abdominal Aortic Aneurysm (AAA) is an aneurysm in the lower part of the aorta, the large artery in the torso.
Pressure from inside the artery causes the weakened area to balloon out beyond the normal width of the blood vessel. Over time, the weakened area can continue to expand. Interventional radiologists are experts in vascular diagnosis and imaging interpretation and are an integral part of the team for their treatment.
What are the symptoms?
Many people show no symptoms and do not know they have an aortic aneurysm until it ruptures, earning AAA the name “silent killer.” If symptoms do occur, you may experience pain in the groin, abdomen, chest, back or near the naval. Sometimes, AAA causes a pulsing sensation like a heartbeat in the abdomen. An extremely sharp and severe pain may indicate rupture, requiring emergency medical treatment. Blood clots can also develop in the aneurysm, which can break off, travel and block the arteries to the legs resulting in loss of blood supply to the limb.
Other medical conditions can cause similar symptoms. Always consult your doctor to be sure.
Am I at risk?
While exact cause of Abdominal aortic Aneurysms is not fully known, multiple risk factors are identified. Among the strongest is a long, continued history of smoking. Being male above the age of 60, the presence of Peripheral Arterial Disease (plaque build-up in the blood vessels), as well as family history are all felt to play a role. While the risk of having an aortic aneurysm is much higher in males, the risk of rupture appears to be higher in women.
How are Abdominal Aortic Aneurysms diagnosed?
A medical history and physical exam will be conducted by your interventional radiologist. Screening of Abdominal Aortic Aneurysms is recommended in patients with the appropriate risk factors.
Screening is typically performed with an ultrasound which is used to evaluate the abdomen, specifically the aorta and selected branches. If further evaluation is needed for a suspected abnormality, a CT or MRI can be pursued at the discretion of your interventional radiologist.
What are my treatment options?
It is important to note that while you may have an abdominal aortic aneurysm, the presence of an aneurysm alone does not mean it needs to be treated. The management of an aneurysm is primarily dependent on its size. Other factors would include new symptoms, and rapid growth.
There are numerous management options for AAA which range from conservative monitoring to surgery.
Part of your care for an abdominal aortic aneurysm includes:
- Managing risk factors. This includes stopping smoking and increasing exercise.
- Medicine. This includes managing cholesterol, blood pressure, and cardiac risk factors.
- Monitoring. Ultrasound, and occasionally a more invasive exam such as CT scan or MRI will be used routinely to monitor the size of the aneurysm.
Characteristics of your aneurysm will help determine which method of treatment/repair is better. There are risks and benefits to both approaches, and your interventional radiologist will help guide you through the decision-making process:
- Endovascular aneurysm repair (EVAR). Unlike open repair, EVAR requires only small incisions in the groin. A CT scan is typically obtained prior to plan the procedure. The patient is then taken to the angiography lab and using X-ray guidance, the interventional radiologist can repair the aneurysm by inserting the stent or graft inside the aorta.
- Open Surgery. This is performed by a vascular surgeon. To surgically repair an abdominal aortic aneurysm, an incision is made in the abdomen. The surgeon will then exclude the aneurysm by suturing a graft, connecting it from one end of the normal aorta to the other. This “open repair” is considered the surgical standard for an abdominal aortic aneurysm. However, this approach typically has its own risk profile related to anesthesia and the operation.
Am I a Candidate for AAA Repair?
Whether a repair is appropriate, and if so what type, is a decision that is arrived upon after careful evaluation of your history and your imaging. You will have this discussion together with your interventional radiologist. Not all patients are good candidates for any one option.
Endovascular Aneurysm Repair
- Minimally invasive – can be done entirely from the skin with a few small incisions
- Significantly lower risk of complications and death post-operatively
- Equivalent success to open repair in correctly chosen patients
- Not everyone is a good candidate based on the type of aneurysm
- Requires long term monitoring for life using CT scan or ultrasound
- Can result in multiple additional minor angiographic procedures to achieve complete success
Open Surgical Repair
- Considered the gold standard for aneurysm repair and is extremely durable long-term
- Requires few, if any, repeat long-term procedures and typically does not need yearly CT scan for monitoring
- Aneurysm type does not exclude patient from repair
- Large operation with midline incision
- Increased risk of short-term complications and death
- Requires general anesthesia
Would you like to talk with one of our interventional radiologists about the diagnosis of AAA or which treatment is best suited for you?
We will walk you through the process and answer any questions you may have.
Why Choose Fairfax Vascular Center?
Fairfax Vascular Center is one of the largest, long-established interventional radiology practices with more than 100 years of combined clinical experience.
Our interventional radiologists have the largest collective experience in the region on endovascular repair of aneurysms ranging from simple to highly complex. As a practice we have access to the latest devices and technology.
Our physicians are available 24/7 to ensure you are well taken care of from the time of consultation through your treatment and follow up.
Fairfax Vascular Center is part of Fairfax Radiological Centers, the largest and oldest diagnostic radiology group in the metro DC and surrounding region, allowing us to provide our patients with leading edge-imaging technologies and the most experienced diagnostic and interventional radiologists with subspeciality training.
We firmly believe that multidisciplinary care is in the best interest of our patients and closely partner with our vascular surgery team to make sure that your care is in the best hands and you gain the best possible outcome.
Why would my physician recommend an AAA procedure?
Your physician may recommend AAA screening if you have a small abdominal aortic aneurysm and there are no symptoms present. An AAA repair will be recommended if the abdominal aortic aneurysm is large or growing and symptoms are present.
How does an AAA procedure work?
During this procedure small incisions are made in the groin and using X-ray guidance, the interventional radiologist can repair the aneurysm by inserting the stent or graft inside the aorta.
What do I need to do before an AAA procedure?
You will be given detailed instructions by our staff before your procedure. In general, do not eat or drink anything after midnight the night before your procedure. This includes breath mints, gum and tobacco. Patients should notify staff if they are diabetic, taking anticoagulants (blood thinners) or allergic to anesthesia. Be sure to bring your insurance card, photo ID and list of current medications (dose and frequency).
What will I feel during an AAA procedure?
You may feel a slight sting when the needle is inserted for the IV line and the anesthesia. You will feel relaxed and sleepy during the procedure.
What should I expect after an AAA procedure?
Immediately after recovery from the stent grafting procedure, you may be required to lay flat for four to six hours.. Some mild discomfort may be felt at the incision sites. This usually resolves in two days. Side effects may include swelling of the groin area, numbness of the legs, nausea, vomiting, leg pain or throbbing, lack of appetite, fever and/or absence of bowel movement for one to three days.
If you experience any of the following symptoms, contact your doctor immediately: Pain, numbness, coldness or weakness in the legs or buttocks, back, chest, abdominal or groin pain, dizziness, fainting, rapid heartbeat, or sudden weakness.
How can I schedule an AAA procedure with Fairfax Vascular Center?
When are appointments offered for AAA procedures?