What is an Aneurysm?
An aneurysm occurs when a weakened artery balloons out rather like a worn motor car tire. Most aneurysms grow very slowly over many years but eventually the wall of the artery may become so weakened that it ruptures. The most common artery to be affected in this way is the aorta, which is in your abdomen. Rupture is often fatal.
How is an Abdominal Aortic Aneurysm detected?
Most aneurysms give no trouble until they rupture, but some patients have their aneurysm diagnosed coincidentally when they are examined or if they have a scan for another problem (e.g. prostate trouble or gallstones). Some become aware of a feeling of pulsation in their abdomen, and as the aneurysm stretches, it can also cause tummy or back pain.
If an aneurysm is suspected, your primary doctor will refer you to a Vascular Specialist for advice. An ultrasound or CAT scan is then performed. This is a painless test that can determine whether an aneurysm is present and measure its size.
Who is at risk?
Men over the age of 65, younger men with a brother or father who has had an aneurysm, or men with other arterial disease are known to be at risk. Smoking and high blood pressure are also known to increase the risk. In some areas of the country, people at increased risk of having an abdominal aortic aneurysm are being offered screening by an ultrasound scan.
Do I need treatment?
Not all aneurysms need treatment. The risk of rupture, and therefore the need for repair, depends on the size of your aneurysm. The risk of a small aneurysm rupturing is less than the risk of repairing it. If the aneurysm becomes larger than 5.5cm in diameter, it is probably safer to repair it than to leave it alone. Apart from size, the decision when to repair an aneurysm depends upon the presence of symptoms, other medical problems, and your overall fitness.
Small aneurysms are usually observed by regular ultrasound scanning at 6 to 12 monthly intervals in the vascular laboratory. The average enlargement is about 0.5cm per year, but some aneurysms stay the same size for many years. Once an aneurysm becomes big enough to consider repair, a CT scan is performed to find out more information about its size and shape.
What does treatment involve?
There are two methods of treatment available: open repair and endovascular repair. Both have advantages and disadvantages.
Open surgical repair involves sewing in a new plastic tube (graft) to replace the weakened section of the aorta. The operation is done through an incision in the abdomen under a general anaesthetic. The actual risk varies from patient to patient and largely depends upon the presence of other medical problems. You will need to stay in hospital for 5-7 days, and then about 6 weeks recovery at home. This operation has been done for many years and is known to be very reliable.
Endovascular repair is a newer method. It involves inserting a new lining (stent-graft) into the aorta through small incisions in the groin. It only requires a couple of days in hospital and recovery is much quicker. Endovascular repair does not provide as good long-term protection as an open repair from subsequent leaks. This means that regular scans will be required to detect any leaks. Most leaks can be dealt with by further treatment but very occasionally conversion to an open repair becomes necessary.
Not all aneurysms are suitable for endovascular repair. The choice of treatment method will depend upon the shape of your aneurysm, your overall fitness for treatment, other medical problems, and your preference. Your vascular specialist will advise you on the best treatment for your specific circumstances. Further information is also available.
How can I help myself?
There is nothing you can do about the aneurysm. Improving your general health by taking regular exercise, losing weight and stopping smoking are helpful measures, even if you do not need treatment at present. Good control of other medical problems like diabetes and high cholesterol are also important.