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What are my treatment options?

Once an AAA reaches 5.5 cm the risk of it bursting is sufficiently high to justify surgical intervention to fix it. Until a decade ago, there was only one option for fixing an AAA - open surgical aneurysm repair. In 1990 Juan Parodi performed the first endovascular (keyhole) repair of an AAA. It took a number of years since then for this new technique to be accepted. The technology has since been refined and the keyhole technique is now available for routine use.

 

What happens when my AAA reaches 5.5 cm?

Do I need any special tests before my operation?

If I am suitable for EVAR should I still consider an open procedure?

What does open abdominal aortic aneurysm repair involve?

 

What happens when my AAA reaches 5.5 cm?

I usually start planning treatment when the AAA exceeds 5 cm, since by the time the patient comes to surgery the AAA would have reached 5.5 cm. This gives us time to assess the patient's fitness for surgery and the aneurysm's suitability for an endovascular (keyhole) technique.

Do I need any special tests before my operation?

All patients will have a CT-scan to allow us to decide if we can do an endovascular (key-hole) procedure. If we can do a keyhole procedure, we will use the pictures of the aneurysm to plan the stent-graft. All patients will have a standard pre-op assessment by our vascular nurse specialist which includes some blood tests and an ECG (heart trace). If you are having an endovascular (keyhole) procedure and there is no history or signs of cardiac (heart) or respiratory (breathing) pathology (illness) we will only perform an echocardiogram (heart scan). All other patients will have a detailed cardiopulmonary assessment known as CPX.

If I am suitable for EVAR should I still consider an open procedure?

I am of the opinion that you should have endovascular surgery, reserving an open surgical procedure only for when there is no endovascular option. This is because patients who have an EndoVascular Repair of an Abdominal Aortic Aneurysm (EVAR) when compared to those having an open repair:

 

  1. will have  two small scars in the groin (like for a hernia or varicose vein operation) as opposed to a large scar extending along the entire length or breath of the anterior abdominal wall
  2. are much less likely to die from the procedure
  3. are much less likely to develop serious complications from the procedure
  4. stay in hospital for a much shorter period (usually 3 days as opposed to 10 days or more)
  5. may have the procedure under an epidural (as is administered to women in labor)
  6. will be able to drink and eat immediately after the procedure (rather than having to wait till bowel function returns)
  7. will have an equally effective procedure in dealing with their aneurysm
  8. will return to your usual self within a week or so rather than taking at least 6 months with an open procedure

 

The only disadvantage of EVAR is that it requires long-term follow-up by ultrasound or CT scanning.

 

For a more detailed explanation on why I prefer EVAR click here.

 

What does open abdominal aortic aneurysm repair involve?

In this procedure a large incision is made in the abdomen, the bowel is brought out to one side and the aneurysm is opened between clamps to prevent blood flowing through the aneurysm whilst repairing it. A synthetic graft (see diagram below) is stitched into place between normal aorta above the aneurysm and the arteries going to the legs below it. During this time there is no blood flowing to the lower body. Once the joints between the graft and arteries are secure, the clamps are released and blood flow restored to the lower body.  This is a very major operation and even if you are considered ‘fit for surgery’ the chance of dying from it is 5%. This risk is higher if you suffer from other medical problems. I now perform this operation only if there is no endovascular option (unless the patient requests otherwise).

 

 

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