Abdominal Aortic Aneurysms & Visceral Artery Aneurysms

An abdominal aortic aneurysm also known as a AAA occurs in the lower part of your aorta, this is your body’s major artery. They grow at different rates and can present with symptoms such as new onset back or abdominal pain and/or a pulsating sensation near your belly button.

If you have been diagnosed with a AAA and have new onset abdominal or back pain you must present at your nearest Emergency department as this is considered a surgical emergency.

AAA are often found incidentally on CT scans during other health concerns and can be diagnosed at many different sizes. The aorta is the main blood vessel in the body it starts at the heart and goes upwards before arching over backwards in the chest and travelling down in front of the spine. At belly button level it splits into two, one large artery for each leg. Along the way it gives off blood vessels to the arms, head neck and brain and then once it enters the abdomen gives off arteries to the bowel and kidneys.

What is an Aneurysm

An aneurysm is a weakness in any artery wall of the body and over time this weakness causes a bulge or dilation. This most commonly occurs in the aorta below the kidney arteries before the aorta splits into two. The problem with aneurysms is they are like a balloon the bigger they get the more likely they are to rupture. A ruptured aneurysm is a life-threatening emergency. Once an aneurysm is discovered (often incidentally while scanning for unrelated conditions) it needs to be monitored until it reaches a size when it should be repaired in a planned fashion. Some aneurysms may never reach a size that requires surgery.

Investigations for aneurysms are usually done with an ultrasound or CT scan. Ongoing surveillance can be conducted with either of these methods as required.

Risk factors for aneurysm formation are:

Smoking
High blood pressure
High cholesterol
Family history
Being male
Being > 65yrs of age
Multiple genetic conditions
Ehlers-Danlos and or Marfan syndrome

Patients with genetic conditions tend to have aneurysms at much younger ages than those with aneurysms caused by other risk factors. If you have been diagnosed with a AAA it is highly recommended that you cease smoking, exercise regularly and speak with your doctor regarding controlling your Blood Pressure and Cholesterol.

The risk of rupture of the aneurysm is weighed up against the risk of the operation to repair it, most aneurysms are repaired between 5 and 5.5 cm in size.

AAA Surgery

If a patient is medically fit enough for surgery there are two approaches to repair an aneurysm.

The first approach is an open repair where an incision is made into the abdomen. The vessels above and below the aneurysm are clamped and a section of the aorta is replaced with a prosthetic graft. This surgery is often performed on younger and physically well patients.
The second approach is an EVAR (endovascular aortic repair) in which a small incision is made into the groin and a stent is passed on a delivery device into the aorta and then deployed where it re-lines the aorta. The use of Xray’s and contrast dye will help Dr McGlade guide the graft for optimal positioning.

Multiple factors are taken into account when deciding which approach is more appropriate. There are pros and cons to both of the treatment options and these will be discussed in detail prior to formulating a treatment plan.

Associated Aneurysms with AAA and Screening

Aneurysms of the arteries supplying the bowel and other organs in the abdomen are rarer than those that affect the aorta. These aneurysms are repaired at different sizes and are usually able to be repaired via a key hole approach.

Aneurysms in the abdomen are also associated with aneurysms behind the knee, called Popliteal aneurysms. Popliteal aneurysms behave a little differently, the larger they get rather than bursting they tend to block suddenly. This causes the leg below that to lose blood supply which is a surgical emergency. For this reason, any time a patient is found with a new AAA Dr. McGlade will organise a scan to check for aneurysms behind the knee.

When you have aneurysms in your abdomen there is also a risk of having aneurysms in your chest. Upon the first review Dr. McGlade will organise for a screening CT scan of the chest to look for any aneurysms. If the scan comes up clear then no further chest surveillance is required.

Because there can be an association with family members having aneurysms, guidelines recommend that any of your first-degree relatives are checked for aneurysms between the age of 60 and 65. This can be done with an ultrasound organised by their local doctor. If an aneurysm is found then a vascular review is warranted, however if no aneurysm is seen then there is no need for ongoing surveillance. AAA’s usually develop later in life and screening from the age of 60 is appropriate.

Initial Consult with Dr McGlade

Aneurysm surgery is a sub specialty interest area of Dr McGlade. He has developed advanced skills in both open and minimally invasive techniques of aneurysm repair. In your initial consultation he will perform a thorough history and examination. He will then take the time to explain to you and your family causes of aneurysms and the indications for repair or continued surveillance.

. He will also discuss other factors relevant to the new diagnosis of an aneurysm such as further screening which includes behind the knee, chest and family screening and medical management. Medical management includes implementing blood pressure control and prescribe medications to decrease the risk from arterial disease. And most importantly answer any questions or concerns you have about your diagnosis.

Treatments

Meet Our Doctor

Dr Daniel McGlade

Endovascular & Vascular Surgeon
MBBS, FRACS (Vasc)