Aortic Aneurysm Surgery

An aortic aneurysm is an abnormal bulging of the large artery bringing blood to the body. Most are located below the kidneys and are termed infra-renal abdominal aortic aneurysms (AAA). The aneurysm may involve only the aorta itself as seen at left by the reconstructed x-ray image seen in gold color, or they may involve other arteries originating from the aorta. The most commonly involved arteries are the iliac arteries, which feed the pelvis and legs. These arteries are seen at left immediately below the large, bulging aneurysm. When an aneurysm grows too large, there is increasing tension on the blood vessel wall, much like a bulging area on a tire inner tube. If the tension becomes too great, the AAA may rupture. This is a life-threatening occurence.

In the past, the only treatment for aortic aneurysms was a large abdominal incision, opening of the aneurysm, and replacement with an artificial graft made out of Dacron or Goretex. The graft could be in the shape of either a straight tube or an inverted "Y" as shown at right. Actually, the picture shows the next generation of grafts used to treat abdominal aortic aneurysms - the Endograft. Instead of a large incision in the belly, this type of graft can now be placed through small incisions in the groins. Using endovascular techniques and x-ray visualization, the endograft can be inserted like an internal pipe or sleeve within the AAA itself. This excludes the bulging aneurysm from blood flow under pressure, creating a smaller channel for blood flow right down the middle of the AAA. The picture below depicts the endograft in place.

Patients can usually be discharged home from the hospital the day after the operation, compared to at least a week in the hospital with the older open abdominal technique. Recovery time is much shorter, and patients can return to work or recreational activities much more quickly. Not every patient with an AAA is a candidate for this type of repair, so one must confer with the surgeon to determine the best course of treatment. In some cases no surgical treatment is required due to the small size of the aneurysm. Patients must consult their physicians for the most appropriate course of action. Click here to view a video of the use and deployment of the endograft in the treatment of an abdominal aortic aneurysm.