What is an Aneurysm?
Aneurysms result from weakening and stretching of an artery, which balloons out. Just like a balloon if the artery stretches too much it can burst. Most patients who suffer a burst aortic aneurysm do not survive.
The most common artery to be affected in the body is the aorta. The aorta is the main artery in the abdomen. The normal aorta measures about 2 cm in diameter.
Most patients who need surgery for an abdominal aortic aneurysm are men over the age of 65 years.
1 in 10 men over 65 may have some enlargement of the abdominal aorta. About 1 in 100 will have a large aneurysm requiring surgery.
How is an Abdominal Aortic Aneurysm (AAA) detected?
An aneurysm may be detected when your Doctor examines your abdomen, but many cannot be felt. Occasionally, a patient may become aware of a feeling of pulsation in the abdomen. On rare occasions, a lump can be visible.
An ultrasound examination of the abdomen is a very good way of finding an aneurysm. This is a painless procedure where an ultrasound probe is pressed gently on the abdominal skin. The scan will tell you if there is an aneurysm present and exactly how large it is. Christchurch Radiology Group (03 379 0770 or 0800 TOXRAY) can perform an ultrasound scan for you.
Some patients have the aneurysm diagnosed by chance when they are examined for another problem, or if they have a scan for a different medical reason (kidney problems or gallstones, for example).
As the aneurysm stretches, it may cause abdominal or back pain. Sometimes the aneurysm is first discovered when this pain is investigated.
If an aneurysm is suspected, your GP will refer you to a Vascular Surgeon for advice. Either your GP or specialist will arrange further scans scan.
Who is at risk?
Aneurysms are much more common in males than females.
It is known that men over the age of 60, and younger men with a brother or father who has had an aneurysm, are at risk.
Men with other arterial diseases (angina or hardening of the arteries) smokers and patients with a history of high blood pressure are also at risk.
Do I need surgery?
Not all aneurysms need an operation. The risk of rupture and therefore the need for an operation depends on the size of the aneurysm (the risk of rupture increases as the aneurysm gets bigger). If an aneurysm is causing symptoms the Vascular Specialists at CVG will usually recommend surgery.
For men, if the aneurysm is larger than 55mm in diameter, it may be safer to have an operation to repair it than to leave it alone. For women surgery may be recommended when the aneurysm reaches 50mm.
Because the operation itself carries some risk, the exact size at which your surgeon will advise an operation will also depend on any other health problems that you may have. For instance, if you have heart, lung, or kidney problems an operation may be more risky for you than for some other patients.
Once repaired, the risk of rupture virtually disappears.
Ideally, an operation is advised when the threat of the aneurysm bursting (which is usually fatal) is more than the risk of an operation.
If your aneurysm is smaller than the size at which operation is needed, your Specialist will arrange further ultrasound scans to monitor the rate of growth.
If an aortic aneurysm ruptures, the chances of survival are not good. Overall only 2 in 10 people will survive. Half the patients with aortic rupture will die before they reach hospital.
Your Specialist Vascular Surgeon will give you a clear explanation of the options in your case.
What does surgery involve?
There are 2 ways to fix abdominal aortic aneurysms.
The first is open surgery involving a cut across the abdomen and replacing the aneurysm with an artificial artery made of a very strong synthetic material called Dacron®.
The second way to fix aortic aneurysms is a “key hole” technique where 2 cuts are made to expose the arteries at the top of the legs. Then under X ray guidance an artificial artery (stent graft) is pushed up into the abdomen through the arteries at the top of the leg. This procedure is called endovascular aneurysm repair (EVAR).
The artificial artery should last for the rest of your life and it is very unlikely that it will need to be replaced. If you undergo EVAR you will need annual X rays and ultrasound scans to ensure the stent graft is staying where it is meant to.
Is surgery successful?
If aneurysms are successfully repaired, there is a very high likelihood that you will return to a normal life. Full recovery times vary between 3 and 6 months, depending mostly on your age. Your surgeon will discuss any special risks of surgery in your particular case with you.
How can I help myself?
As far as we are aware, there is nothing you can do which will make the aneurysm worse, but there is also nothing you can do to make it better.
Improving your general health by taking regular exercise, rigorous control of blood pressure, losing weight and stopping smoking are helpful even if you do not need an operation at present.
More information is included in the PDF files below which you are welcome to download and read.
If you have any questions or wish to discuss anything further, please don’t hesitate to contact us.
