If you have been diagnosed with a AAA, a vascular surgical consultation is key to evaluating your next steps. The surgeons at Lake Washington Vascular are specialty trained vascular and endovascular surgeons who are experts at evaluating, managing and fixing AAA’s. With the help of the entire Lake Washington Vascular staff, they can determine the size of your aneurysm, the need for follow-up ultrasounds, and when repair (surgery) is needed. Once your aneurysm is repaired, a schedule of maintenance visits will keep close tabs on your aorta.
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Two methods currently exist to repair AAA.
The first, and most common, is called endovascular stent-grafting. Based on minimally invasive techniques, catheters are place into your arteries through small incisions in the groins. These catheters contain grafts that can be deployed in such a way as to seal off the aneurysm while continue blood flow through the main aorta (imagine replacing the inner tube of a tire, rather than replacing the whole tire). This technique is very effective, and very well tolerated with patients recovering quite quickly from the surgery.
The second method, called open repair, is done through an incision into your abdomen or flank to expose your abdominal aorta. Once there, the aneurysm is opened and a graft is sewn into its place, thus completely replacing that segment of the aorta. Although this is more invasive than endovascular repair, it is extremely long-lasting and time-tested. Furthermore, not every patient is a candidate for the endovascular stent graft due to the shape of the aorta and other factors.
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Again, because we know how aneurysms grow and behave, a great deal of work has studied the optimal timing of fixing them. In the past, all aneurysms were fixed as soon as they were discovered; we have changed that attitude for two reasons: 1) small AAA’s very rarely ruptured, and 2) the risk of surgery to fix AAA itself carried a definite risk of complications.
Based on these facts most surgeons agree that AAA’s less than 5 cm in diameter have a low risk of rupture – low enough that it does not justify the risk of surgery. Greater than 5cm AAA’s begin to carry higher risk of rupture over time, and therefore do warrant fixing the aneurysm for the prevention of a future rupture.
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Although the risk of rupture makes having a AAA very worrying for you, we know that it is very much a manageable condition. The first thing to realize is that AAA’s expand quite slowly and predictably. They are also fairly easily to track (in terms of size and shape) with ultrasounds done regularly over time (once or twice yearly). In the meantime, maintaining healthy living is your best action. Smoking is not only a cause of AAA, but it is also a high risk factor for causing a ruptured AAA; so smoking cessation is our first goal in AAA patients who smoke. Also, keeping your blood pressure in a good range, and maintaining healthy cholesterol levels will benefit you.
There are not many things to avoid, even if you have a AAA. Excessive strenuous lifting (say, lifting greater than 30 pounds repeatedly) may elevate your blood pressure and therefore should be avoided. However other forms of exercise are still beneficial.
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In the end there is no one single cause, but we do know there are factors that put a person at increased odds to develop AAA, some treatable, some not. First and foremost of the preventable causes is smoking. Although not all smokers get AAA’s, and not all AAA patients are smokers, we know that patients who do smoke have higher rates of AAA. Other common factors include long-term high blood pressure, cholesterol issues (hyperlipidemia), age greater than 60, and male gender (AAA is more common in males). An important risk factor for AAA is family history. While it is not a true genetic condition passed down from one generation to the next, it definitely is seen more commonly in patients with family members who have AAA than patients without such family histories.
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The vast majority of patients with AAA do not realize they have it (they are asymptomatic). Some people may notice back pain, although this is not usually the case. Most AAA’s are discovered by scans or studies that were done for other reasons (such as looking for kidney stones or gallbladder disease). The two most common tests for discovering and following AAA’s are abdominal ultrasound and CT scans. Screening ultrasounds of the abdomen discovers some AAA’s. Find out if a screening ultrasound makes sense for you.
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Unlike a balloon, the aorta usually ruptures in a small focal spot. However with such high-flow through the aorta, this is enough for massive bleeding (internal bleeding). The result can be catastrophic. Half of all patients with ruptured AAA do not survive long enough to reach the emergency room. Clearly, our emphasis for our patients is to fix an aneurysm before it ruptures.
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As the wall of the blood vessel weakens, that part of the artery expands. Over time as the artery wall expands it becomes thinner (imagine the walls of a balloon as it gets increasingly inflated). The abdominal aorta is approximately 1 inch (2.5 cm) in diameter; aneurysms can expand that diameter to 2 inches or greater (5 cm or more) at which point they have a much higher risk of rupturing.
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An aneurysm is a weakening of the wall of a blood vessel that results in that local segment of the blood vessel ballooning or expanding. Think of a weak spot in a tire that develops an outpouching because pressure pushes that point outwards. In our bodies, a very common location for aneurysms is the aorta (the largest artery in our body that courses from our heart to the lower abdomen). By far the most common spot for an aortic aneurysm to form is in the lower abdomen, below the kidneys. This is referred to as an Abdominal Aortic Aneurysm (AAA).