What are the symptoms for AAA?
There are no symptoms for AAA. About 90 percent are discovered by accident, when a physician is testing for another condition such as gall stones or kidney stones. Although a doctor can sometimes detect an AAA just by feeling the abdomen, ultrasound is the best method. "For someone over 60 who is at risk, it’s not a bad idea to have an ultrasound," said Dr. Arepally.
What is AAA or abdominal aortic aneurysms?
An AAA is a weakening in the wall of the abdominal portion of the aorta, which leads from the heart to the rest of the body, and is the body’s largest blood vessel. AAA most commonly is caused by atherosclerosis, a gradual build-up of cholesterol and scar tissue that damages the walls of blood vessels. People with high blood pressure, those who smoke and those who have a family history of AAA also are at risk. The aorta is an inch or less in diameter. Typically, aneurysms that cause a ballooning of the aorta smaller than 2 inches in diameter are not treated. Those 2-1/2 inches or larger are at risk for life-threatening rupture, and usually are repaired. Patients whose aneurysms are detected at the smaller size typically are checked regularly by their physicians.
How frequent are abdominal aneurysms?
Abdominal aortic aneurysms occur in 5 percent to 7 percent of people age 60 or older, and men are four times more likely to have AAA than women. Every year, more than 15,000 people die of AAA, making it the 13th leading cause of death in the United States.
How are these new devices used to treat AAA?
The interventional radiology technique involves making a small nick in the groin and, under X-ray guidance, inserting a catheter into a blood vessel that leads to the aorta. A collapsed stent-graft, also known as an endograft (a small fabric tube) is inserted through the catheter and moved to the site of the aneurysm, where it is deployed, reinforcing the aorta and creating a stronger pathway for the blood. Blood flowing through the stent-graft no longer puts pressure on the ballooning walls of the aneurysm that are outside of the graft. Typically the patient is lightly sedated and has been given epidural anesthesia.
How can you treat AAA with this new technique?
This new technique involves the use of a "stent graft". The stent graft is a piece of graft material (similar as to what would be used in the routine procedure), within which have been placed metal stents (a framework) to support and secure the device to the wall of the aorta. Utilizing a surgical "cut-down" in the groin, the interventional radiologist and vascular surgeon work together to place the stent graft within the aorta at the location of the aneurysm to create a new channel for blood flow which effectively excludes the aneurysm from the circulation. The aneurysm clots off, leaving blood flowing through the stent graft in the same fashion as if a "vascular graft" had been placed during the routine type of surgical procedure. After placing the stent graft, the surgeon closes the access site in the groin and the patient is taken to the recovery room.
Who performs the procedure?
At Johns Hopkins, the procedure is performed by a stent graft team. This team is composed of an interventional radiologists, vascular surgeon and anesthesiologists. By combining the different medical expertise, the best and optimal care is provided for patients undergoing this procedure at Johns Hopkins.
How many patients are eligible for this procedure?
Nearly three-quarters of people with an abdominal aortic aneurysm (AAA), a common life-threatening condition, may be eligible for a non-surgical procedure to correct the dangerous ballooning in the body’s main artery.
Interventional radiologists at Johns Hopkins perform the procedure, called stent-grafting, which requires less anesthesia and a shorter hospital stay, and results in less overall risk to the heart than surgery. "In the right patient, stent-grafts are very successful in treating these aneurysms," said Dr. Lund. "Stent-grafting has many advantages over surgery, including a dramatic reduction in the complication rate."
What is the recovery period for this new method?
The hospital stay usually is four days or less; recovery takes an average of 11 days and there are fewer complications than with surgical repair. The alternative, surgical replacement of the damaged portion of the aorta, is performed under general anesthesia. A large incision is made in the abdomen to reach the site. The aorta is clamped off, the aneurysm cut out and an artificial artery or graft is sewn into place. Typically, the hospital stay is 8 to 10 days and the average recovery time is 47 days.
How effective is the treatment?
About 15 percent to 20 percent of patients who have the stent-graft procedure experience leakage into the aneurysm sac. Many need no treatment, but are followed closely. Others may undergo embolization, an interventional radiological technique that cuts off blood flow to the problem area to prevent further leakage.
An interventional radiologist is a physician who has special training to diagnose and treat illness using miniature tools and imaging guidance. Typically, the interventional radiologist performs procedures through a very small nick in the skin, about the size of a pencil tip. Interventional radiology treatments are generally easier for the patient than surgery because they involve no surgical incisions, less pain and shorter hospital stays.
Why do AAA occur?
Atherosclerotic disease, or "hardening of the arteries", can result in aneurysm formation (ballooning) of the abdominal (belly) and/or thoracic (chest) aorta, the main blood vessel of the body. This disease can have profound effects on one's health and can even result in death should the aneurysm rupture. These aneurysms have traditionally been treated with surgery, however this major operation can be associated with a significant recovery time and morbidity and mortality rate. Recently, a new method of treating these aneurysms, combining the skills of both a vascular surgeon and interventional radiologist, has been developed.
How new is this technique?
This device has been used successfully around the country and in Europe to treat aortic aneurysms, and certain grafts have been recently been approved by the FDA for the U.S. Each patient is fully evaluated to see if they are a candidate for this procedure. If you have been told that you have an "abdominal aortic aneurysm" or "thoracic aortic aneurysm" and are not a good surgical candidate, you may obtain further details concerning this state-of-the-art procedure. Please feel free to contact us at any time.
If you are interested in coming Johns Hopkins Hospital for this procedure, please feel free to contact us.
Drawing of an abdominal aneurysm. This new technique is used to treat the abnormal dilatation of the blood vessel, called an aneurysm, by placing a graft in the blood vessel with out the need for major surgery. This has been a significant development in the treatment of this condition.
Picture of the aneurysm with and without the graft. This graft is placed with minimally invasive techniques and has been considered a major breakthrough in the treatment of aneurysms.