Endovascular treatment of abdominal aortic aneurysm
Definition | An aneurysm of the abdominal part of the aorta or a AAA/Abdominal aortic aneurysm is a local or diffuse expansion of its diameter of more than 4 cm. The progressive expansion of the aorta leads to thinning of the walls of the aneurysm and at any time can be complicated by rupture of the vessel and fatal bleeding. The disease is mainly acquired and is caused by atherosclerosis, nonspecific aortoarteritis, specific arteritis (tuberculosis, syphilis, rheumatism, salmonellosis). Among the congenital causes of the formation of abdominal aortic aneurysms, fibromuscular dysplasia is distinguished. | |
Risk factors | The risk of developing an aneurysm are higher in men, smokers, and the elderly, so for male smokers aged 65-75 years, a physician or family doctor may recommend screening for the presence of an aneurysm. The risk of developing the disease is further increased in people whose relatives have had an aortic aneurysm. This group of patients should undergo regular examination (ultrasound of the abdominal cavity) to detect aneurysm, starting at the age of 60 years. Age, smoking, and a family history of aneurysm significantly increase the risk of aneurysm in men, whether these factors affect women is currently unknown. | |
Symptoms | The majority of aortic aneurysms are asymptomatic: the rate of aneurysm growth is different in different patients, and it is almost impossible to predict how quickly the risk of complications will arise. At the same time, it is known that the faster the aneurysm grows, the higher the risk of aneurysm wall rupture and bleeding. As the size of the aneurysm grows, symptoms of the disease appear, including:
Any of the symptoms listed in this section require immediate medical attention. | |
Diagnostics | Evaluation for a suspected abdominal aortic aneurysm includes assessment of the patient’s personal and family history and physical examination. To confirm the diagnosis are carried out:
Abdominal aortic aneurysms are often discovered incidentally during examination for other indications. For example, during a routine examination, the doctor may feel a pulsating swelling in the abdomen or hear a specific murmur on auscultation of the abdomen. An aneurysm may also be found incidentally on a chest X-ray or an ultrasound of the heart or abdomen performed for other reasons. | |
Complications | The most common and severe complication of an abdominal aortic aneurysm is rupture of the aneurysm wall. The rupture may be incomplete (aortic dissection) or complete (with a violation of the integrity of the vessel). The rupture of the aneurysm leads to internal bleeding, which often ends in the death of the patient. Another common complication of an abdominal aortic aneurysm is an increased risk of blood clots. Thrombotic masses are deposited along the walls of the aneurysm; blood clots break off and spread through the bloodstream and can block blood vessels, disrupting blood flow in various organs (kidneys, abdominal organs) and parts of the body (legs). The result of thromboembolism is a violation of the blood supply to organs with severe tissue damage. | |
Treatment | The most modern treatment for aortic aneurysms is endovascular stenting. The operation is performed inside the vessel using a special catheter, which is inserted into the lumen of the vessel. This type of surgery is minimally invasive. To perform the operation, the interventional radiology only makes a small incision in the inguinal fold, through which the catheter is inserted. During the operation, an X-ray image is taken in real time, which allows the surgeon to control the process of passing the catheter into the vessel. Next, the surgeon inserts a special device, a stent, into the lumen of the aorta. It is a cylindrical wire frame that reinforces the wall of the aorta. The rehabilitation period after this type of operation is only 2-3 days. The main advantages of endovascular intervention are less trauma (invasiveness) and faster patient recovery compared to open access surgery. The type of operation is chosen by a council of doctors, taking into account the location and size of the aneurysm, the age of the patient and other indicators that can affect the effectiveness and risk of the intervention. This high-tech operation is performed by our qualified specialists using the latest methods of endovascular technology. |
Frequently Asked Questions
What is an abdominal aortic aneurysm?
An abdominal aortic aneurysm (AAA) is an enlargement of the abdominal aorta, the large blood vessel that supplies blood to the lower part of the body. It occurs when the vessel wall weakens and bulges outward, often due to atherosclerosis or other vascular diseases. If the diameter expands to more than 4 cm, it is classified as an aneurysm. Without treatment, the vessel may rupture, causing life-threatening bleeding.
What are the symptoms of an aortic aneurysm?
Many aortic aneurysms are asymptomatic and are often discovered incidentally. However, when symptoms do occur, they may include a pulsating feeling near the navel, deep abdominal or back pain, or sudden severe pain indicating a potential rupture or dissection. Rarely, symptoms might involve pain in the legs due to blood clots blocking blood flow.
What causes an abdominal aortic aneurysm?
The primary causes of abdominal aortic aneurysms include atherosclerosis, which is the buildup of plaque in the artery walls, and other vascular diseases like aortoarteritis. Risk factors include age, smoking, and a family history of aneurysms. Congenital conditions like fibromuscular dysplasia can also contribute to aneurysm development.
How is an abdominal aortic aneurysm diagnosed?
Diagnosis of an abdominal aortic aneurysm typically involves a physical exam and imaging tests. Doctors may use ultrasound, CT scans, or MRI to visualize the aneurysm. A CT angiography can provide detailed images, as it involves injecting a contrast dye to highlight the blood vessels.
What is endovascular treatment for an aortic aneurysm?
Endovascular treatment involves placing a stent graft inside the aorta through a minimally invasive procedure. A catheter is inserted via a small incision in the groin, and the stent is guided into place using real-time X-ray imaging. This method offers a quicker recovery and less trauma compared to open surgery.
Who is at risk for developing an abdominal aortic aneurysm?
Risk factors include being male, over the age of 65, a smoker, or having a family history of aneurysms. These factors increase the likelihood of developing the condition. Regular screenings are recommended for high-risk individuals to detect aneurysms early and prevent complications.
What are the potential complications of an aortic aneurysm?
The most severe complication is a rupture, which can lead to massive internal bleeding and death. Other complications include aortic dissection, where the layers of the aorta tear apart, and thromboembolism, where blood clots formed in the aneurysm travel and block blood flow to other organs.
How is an abdominal aortic aneurysm monitored?
Monitoring typically involves regular imaging tests like ultrasounds or CT scans to track the aneurysm's size and growth rate. Early detection of rapid growth can prompt more timely intervention, as the risk of rupture increases with the size of the aneurysm.