Currently, there are three treatment options for AAA:
Watchful waiting –
Small AAAs (less than 5 centimeters or about 2 inches), which are not rapidly growing or causing symptoms, have a low incidence of rupture and often require no treatment other than "watchful waiting" under the guidance of a vascular disease specialist. This typically includes follow-up ultrasound exams at regular intervals to determine if the aneurysm has grown.
Surgical repair –
The most common treatment for a large, unruptured aneurysm is open surgical repair by a vascular surgeon. This procedure involves an incision from just below the breastbone to the top of the pubic bone. The surgeon then clamps off the aorta, cuts open the aneurysm and sews in a graft to act as a bridge for the blood flow. The blood flow then goes through the plastic graft and no longer allows the direct pulsation pressure of the blood to further expand the weak aorta wall.
Interventional repair –
This minimally invasive technique is performed by an interventional radiologist using imaging to guide the catheter and graft inside the patient's artery, rather than making a large incision. For the procedure, an incision is made in the skin at the groin through which a catheter is passed into the femoral artery and directed to the aortic aneurysm. Through the catheter, the physician passes a stent graft that is compressed into a small diameter within the catheter. The stent graft is advanced to the aneurysm and then opened, creating new walls in the blood vessel through which blood flows.
This is a less invasive method of placing a graft within the aneurysm to redirect blood flow and stop direct pressure from being exerted on the weak aortic wall. This relatively new method eliminates the need for a large abdominal incision. It also eliminates the need to clamp the aorta during the procedure. Clamping the aorta creates significant stress on the heart, and people with severe heart disease may not be able to tolerate this major surgery. Stent grafts are most commonly considered for patients at increased surgical risk due to age or other medical conditions.
The stent graft procedure is not for everyone, though. It is still a new technology and we don't yet have data to show he length of time this repair will last. Thus, people with a life expectancy of 20 or more years may be counseled against this therapy. It is also a technology that is limited by size. The stent grafts are made in certain sizes, and the patient's anatomy must fit the graft, since grafts are not custom-built for each patient's anatomy.
A stent-graft is threaded into the blood vessel where the aneurysm is located. The stent graft is expanded like a spring to hold tightly against the wall of the blood vessel and cut off the blood supply to the aneurysm.
- Patients are often discharged the day after interventional repair and typically do not require intensive care stay post-op
- Once discharged, most return to normal activity within two weeks compared to six to eight weeks after surgical repair
Benefits of Interventional Repair
Interventional repair is an effective treatment that can be performed safely, resulting in lower morbidity and lower mortality rates than those of open surgical repair. Benefits include:
- No abdominal surgical incision
- No sutures, or sutures only at the groin
- Faster recovery, shorter time in the hospital
- No general anesthesia in some cases
- Less pain
- Reduced complications
Disadvantages of Interventional Repair
- Possible movement of the graft after treatment, with blood flow into the aneurysm and resumption of risk of growth/rupture of the aneurysm
- Probable lifetime requirement for follow-up studies to be sure the stent graft is continuing to function
Reprinted with permission of the Society of Interventional Radiology © 2004, www.SIRweb.org. All rights reserved.