When considering the risk of abdominal aortic aneurism (AAA) surgery one must consider the risk of avoiding it. It is estimated that one in every 250 people over the age of 50 will die of a ruptured AAA. Treating aneurisms surgically, on the other hand, has a much higher success rate.
The risks of abdominal aneurism treatments vary depending on the…
At academic medical centers with vascular specialists mortality rates are near zero percent. Small community hospitals without specialized surgeons can produce higher mortality rates.
Surgical success rates also depend on the health of the patient. For example, a patient suffering from heart disease has a higher risk of death during surgery. He or she also is more likely to suffer a heart attack during recovery than a patient with no heart disease.
Normally abdominal aneurism treatments include surgury when the AAA reaches or exceeds 5.0 cm in diameter or more than twice the normal size of the aorta. Since normal aorta size varies from person to person the 5.0 cm rule is not the only consideration. Surgical aneurism treatments may be employed for aneurisms between 4 and 5 cm in diameter depending on other factors.
An AAA under 4 cm normally will not be treated surgically, but will be monitored carefully to detect any increase in size. Typically an ultrasound administered twice every year will be recommended. An increase in diameter of more than half a cm in a six-month period will probably warrant surgery.
The good news is that traditional surgical repair of an abdominal aortic aneurism has a very high success rate. After repair is completed only about 5% of patients will require follow-up care.
The procedure involves making an incision in the abdomen and removing the aneurism. The aorta is then fitted with a Dacron patch in order to strengthen the area against further expansion and rupture. The Dacron patch is a tube made out of an elastic material with properties very similar to that of a normal healthy aorta.
In the event of a ruptured abdominal aortic aneurism the first priority is to stop the bleeding. Ruptured aneurisms, even during surgery, are often fatal. Further, damage to major organs can occur during rupture due to blood deprivation.
Once the bleeding has been stopped the patient must be stabilized through the replenishment of blood products. Only after stabilization can other aneurism treatments be administered.
Though this method has a high success rate it is still major surgery. Often an epidural catheter is used - along with general anesthesia - in order to administer sedatives. This not only reduces the amount of inhaled anesthesia but also is used to administer pain control agents during recovery.
The hospital recovery period ranges from five to ten days. Total recovery requires from four to six weeks, sometime longer. In spite of this, open surgical repair is still the gold standard in AAA repair.
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Endovascular coiling is a less invasive method of surgical repair. Because of this it is gaining in popularity in recent years.
This procedure eliminates the abdominal aortic aneurism without the trauma of open surgery. It is especially useful in the treatment of an abdominal aortic aneurism, in part, because of its proximity to the insertion point.
Endovascular surgery results in…
Average recovery time is reduced from the average of six weeks for the open method down to one or two weeks. This is good news for any patient, but especially those who are at high risk because of other factors such as age or pre-existing medical conditions.
This is not to imply that endovascular surgery is the best choice among the abdominal aneurism treatments. It is not appropriate for everyone. This procedure is relatively new. The decision to treat aneurisms by this method as opposed to the traditional "open" method depends on many factors and should be determined by a medical team and the patient. Endovascular surgery should be performed by cardiac and vascular surgeons - those who specialize in blood vessel surgery.
In the procedure a small insertion is made in the femoral artery - in the groin. A special stent consisting of a tube inside a metal cylinder is attached to the end of a catheter. The catheter (thin tube) is then inserted into the femoral artery and guided to the infected area of the aorta using X-ray imaging.
Once the stent has reached the abdominal aortic aneurism and set in place it is secured to the inner aortic wall by devices at each end. It is expanded like a balloon or spring until it fits tightly against the aorta wall.
The blood then flows through the stent-graft instead of putting pressure on the stressed aortic wall that has become the aneurism. The aneurism is completely cut off from the flow of blood and is no longer at risk from rupture. The pressure being relieved, the aneurism will normally shrink and disappear.
The success rate of this type of surgery has risen to around 90%. But it does carry risks such as leakage and infection. Since this technique is a recent development the long-term results are not yet known.
Non-Surgical abdominal aneurism treatments focus on reducing coexisting conditions that tend to increase the likelihood of aneurism expansion and rupture. Surgery is the only cure to date.
However, for certain patients, non-surgical methods are preferable. These include patients with small aneurisms that have a low likelihood of rupture. These aneurisms are generally smaller than 4 cm. (1.6 in.).
Patients with medium sized aneurisms (4 to 6 cm., or 1.6 to 2.4 in.) who also have a limited life expectancy due to other factors such as old age or other illnesses are more likely to receive non-surgical treatments. And patients who are at high risk of death in the event of surgery would receive alternate aneurism treatments.
So far, no medication has been proven in a prospective scientific experiment to reduce the growth rate of AAA's in people, although propranolol - a beta-blocker - has been shown to reduce the incidence of ruptured aneurisms in turkeys and to delay the growth of aneurisms in mice.
Currently the primary focus for non-surgical abdominal aneurism treatments is to help the patient stop smoking and control blood pressure. Hypertension is a known risk factor for aneurism rupture because it increases the pressure on the aneurism. Doctors will often treat hypertension with beta-blockers.
There are also lifestyle adjustments that can help reduce the risk of rupture, and the development of new aneurisms. Whether you are trying to reduce the risk of an existing aneurism or are hoping to prevent the development of a new one, there are a few things that you should do.
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