Nonsurgical Procedure for Treatment of AAAs( Abdominal Aortic Aneurysm )

The aorta is the largest artery in your body, and it carries oxygen-rich blood pumped out of, or away from, your heart. Your aorta runs through your chest, where it is called the thoracic aorta. When it reaches your abdomen, it is called the abdominal aorta. The abdominal aorta supplies blood to the lower part of the body. In the abdomen, just below the navel, the aorta splits into two branches, called the iliac arteries, which carry blood into each leg.

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When a weak area of the abdominal aorta expands or bulges, it is called an abdominal aortic aneurysm (AAA). The pressure from blood flowing through your abdominal aorta can cause a weakened part of the aorta to bulge, much like a balloon. A normal aorta is about 1 inch (or about 2 centimeters) in diameter resulting in an abnormal widening or ballooning greater than 50 percent of the normal diameter (width). However, an AAA can stretch the aorta beyond its safety margin as it expands. Aneurysms are a health risk because they can burst or rupture. A ruptured aneurysm can cause severe internal bleeding, which can lead to shock or even death.
Less commonly, AAA can cause another serious health problem called embolization. Clots or debris can form inside the aneurysm and travel to blood vessels leading to other organs in your body. If one of these blood vessels becomes blocked, it can cause severe pain or even more serious problems, such as limb loss.

The most common location of arterial aneurysm formation is the abdominal aorta, specifically, the segment of the abdominal aorta below the kidneys. An abdominal aneurysm located below the kidneys is called an infrarenal aneurysm. An aneurysm can be characterized by its location, shape, and cause.

The shape of an aneurysm is described as being fusiform or saccular which helps to identify a true aneurysm. The more common fusiform shaped aneurysm bulges or balloons out on all sides of the aorta. A saccular shaped aneurysm bulges or balloons out only on one side.

A pseudoaneurysm, or false aneurysm, is an enlargement of only the outer layer of the blood vessel wall. A false aneurysm may be the result of a prior surgery or trauma. Sometimes, a tear can occur on the inside layer of the vessel resulting in blood filling in between the layers of the blood vessel wall creating a pseudoaneurysm.

WHAT CAUSES AN ABDOMINAL AORTIC ANEURYSM TO FORM?

An abdominal aortic aneurysm may be caused by multiple factors that result in the breaking down of the well-organized structural components (proteins) of the aortic wall that provide support and stabilize the wall. The exact cause is not fully known.

Atherosclerosis (a build-up of plaque, which is a deposit of fatty substances, cholesterol, cellular waste products, calcium, and fibrin in the inner lining of an artery) is thought to play an important role in aneurysmal disease, including the risk factors associated with atherosclerosis, such as:

  • age (greater than 60)
  • male (occurrence in males is four to five times greater than that of females)
  • family history (first degree relatives such as father or brother)
  • genetic factors
  • hyperlipidemia (elevated fats in the blood)
  • hypertension (high blood pressure)
  • smoking
  • diabetes

Other diseases that may cause an abdominal aneurysm include:

  • genetic disorders of connective tissue (abnormalities that can affect tissues such as bones, cartilage, heart, and blood vessels), such as Marfan syndrome, Ehlers-Danlos syndrome, Turner’s syndrome, and polycystic kidney disease
  • congenital (present at birth) syndromes, such as bicuspid aortic valve or coarctation of the aorta
  • giant cell arteritis – a disease that causes inflammation of the temporal arteries and other arteries in the head and neck, causing the arteries to narrow, reducing blood flow in the affected areas; may cause persistent headaches and vision loss
  • trauma
  • infectious aortitis (infections of the aorta) due to infections such as syphilis, salmonella, or staphylococcus. These infectious conditions are rare.

It hase several conservative , surgical and non-surgical treatment . 
Watchful waiting

If your AAA is small, your physician may recommend “watchful waiting,” which means that you will be monitored every 6-12 months for signs of changes in the aneurysm size. Your physician may schedule you for regular CT scans or ultrasounds to watch the aneurysm. This method is usually used for aneurysms that are smaller than about 2 inches (roughly 5.0 to 5.5 centimeters) in diameter. If you also have high blood pressure, your physician may prescribe blood pressure medication to lower the pressure on the weakened area of the aneurysm. If you smoke, you should obtain help to stop smoking. An aneurysm will not “go away” by itself. It is extremely important to continue to follow up with your physician as directed because the aneurysm may enlarge to a dangerous size over time. It could eventually burst if this is not detected and treated.

The procedure uses a catheter to insert a device called a stent graft. The stent graft is placed within the artery at the site of the aneurysm. The blood flows through the stent graft, decreasing the pressure on the wall of the weakened artery. This decrease in pressure can prevent the aneurysm from bursting.

Nonsurgical treatment of AAAs. 

This procedure can be used as  a nonsurgical technique to treat high-risk patients with abdominal aortic aneurysms. This technique is useful for patients who cannot have surgery because their overall health would make it too dangerous.The procedure uses a catheter to insert a device called a stent graft. The stent graft is placed within the artery at the site of the aneurysm. The blood flows through the stent graft, decreasing the pressure on the wall of the weakened artery. This decrease in pressure can prevent the aneurysm from bursting.
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Benefits of the procedure include no general anesthesia (you are awake for the procedure), a shorter hospital stay (about 24 hours), a faster recovery, and no large scars.

About Dr.Nabil Paktin

Cardiologist , M.D.,F.A.C.C.

Posted on May 17, 2013, in Uncategorized. Bookmark the permalink. Leave a comment.

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