Abdominal Aortic Aneurysm (AAA)

Ruptured abdominal aortic aneurysm (AAA) is the 13th-leading cause of death in the United States, accounting for approximately 15,000 deaths per year. It is also the fifth-leading cause of death in men over 60. Current estimates suggest there are 1.5 million abdominal aortic aneurysms in the United States, with 200,000 new cases diagnosed each year.

Many patients are asymptomatic during the early period of aneurysm expansion. Their condition doesn't become apparent until a pulsatile mass is discovered on physical examination or an incidental finding is made on an unrelated imaging study. A major symptom is abdominal or back pain, often sudden and severe, which can signal rapid aneurysm expansion or the onset of rupture. The high mortality rate from aneurysm rupture mandates regular surveillance, currently every six months. An asymptomatic abdominal aortic aneurysm of >5 cm maximal diameter requires timely evaluation for possible intervention.

In 2005, the U.S. Preventive Services Task Force recommended that men 65-74 who had ever smoked, or had a family history of abdominal aortic aneurysm, should be screened for the condition by ultrasound. As a result, Medicare began covering the screening exam for men in 2007. There clearly are female populations at risk for abdominal aortic aneurysm as well. Despite the lack of Medicare coverage, we recommend ultrasound screening for women over age 65 with a history of smoking or heart disease, or a family history of aneurysm.

The goals of aneurysm repair include long-term freedom from aneurysm rupture while optimizing quality of life. Until recently, repair involved large-incision laparotomy with Dacron graft replacement of the aneurysmal segment. Major morbidity and mortality for this operation is typically in the range of 5%, and most patients require a 7-10 day hospital stay and prolonged convalescence. Fortunately, the last decade has seen tremendous advances in aneurysm repair, and most abdominal aortic aneurysms are now treated with endoluminal techniques. Endovascular aneurysm repair (EVAR) uses covered, modular endovascular stents to completely exclude the aneurysm. The latest generation of grafts can be inserted more rapidly than a standard open repair, with less blood loss and significantly less stress to the patient. (1-3)

The recovery period for EVAR is typically much shorter as well. Most patients leave the hospital the next day and have a much abbreviated convalescent period compared to standard open repair. Approximately 70% of abdominal aortic aneurysms may be treated with EVAR, depending on the patient's arterial anatomy.

Several hundred patients with abdominal aortic aneurysms have been treated by the members of Redwood Regional Vascular Associates to date at Santa Rosa Memorial Hospital, with excellent outcomes.

Society for Vascular Surgery - Abdominal Aortic Aneurysm Information

References:

  1. EVAR trial participants: Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomized controlled trial. Lancet. 364(9437):843-8, 2004
  2. Prinssen M, Verhoeven EL, Bluth J, et al: a randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med 351: 1607-1618, 2004
  3. Anderson PL, Arons RR, Moskowitz AJ, et al: A statewide experience with endovascular aortic aneurysm repair: Rapid diffusion with excellent results. J Vass Surge 2004; 39:10-19