Aortic Aneurysm

An aneurysm of the abdominal aorta is a localized “bulging” along the course of the aorta.  It is a condition of unknown cause that is usually seen in somewhat older individuals. The most common location for an aortic aneurysm is just below the origin of the arteries to the kidneys (see diagram) but it can develop in any location along the course of the aorta from the heart to the lower abdomen.

Until rupture occurs, an aneurysm rarely causes symptoms Aneurysms of the abdominal aorta are frequently discovered on routine examination by a physician or during the course of an ultrasound or CT scan that is performed to evaluate a condition such as unexplained abdominal pain. The reason for concern about an aneurysm relates to rupture. If an aneurysm ruptures, death will usually occur within hours.

Many factors are considered when deciding whether any one individual aneurysm should be repaired. General guidelines suggest that when an aneurysm reaches a size of approximately 5.5 cm in diameter or more than twice the diameter of the normal aorta, repair may be recommended to prevent rupture. Since the diameter of the normal aorta varies among individuals, the decision to recommend surgical repair must be individualized for each person. The size of the aneurysm is usually determined by a CT scan after an initial screening ultrasound examination (see photo A and photo B). In certain instances, after a CT scan and ultrasound have demonstrated the presence of an abdominal aortic aneurysm, it may sometimes be necessary to perform an aortogram (see photo C and photo D).

Photo C: This aortogram shows a normal-diameter abdominal aorta without evidence of aneurysm

Photo D: This aortogram shows a very large abdominal aortic aneurysm in the usual infrarenal location, which is approximately at the level of the umbilicus

Repair is accomplished by replacing the weakened segment of the aorta with a prosthetic artery. The aorta is approached via an incision in the flank or abdomen and the prosthetic graft is sewn into the aorta. The prosthetic grafts have been available since the early 1950's. The results of surgery are quite excellent.

Patients who undergo uncomplicated repair of an aortic aneurysm typically will be in the hospital for approximately 6 days. Although patients are usually ambulatory, eating regular food and showering normally at the time of discharge, it is common for patients to feel fatigued for approximately 4-6 weeks after this surgery.

Questions to ask the Vascular Surgeon

Aortic Aneurysm Repair using the Aortic Endograft ("Stent Graft")