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Abdominal Aortic Aneurysm


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An abdominal aortic aneurysm (AAA) is a condition that develops in the lower section of the aorta (the body’s largest blood vessel). These aneurysms can become life threatening when they burst, leading to severe internal bleeding or hemorrhage.

Treating AAAs requires an experienced vascular surgery team — and the University of Miami Health System board-certified experts can help. We are the only academic vascular team in South Florida with the training and experience to handle the simplest to the most complex AAA procedures.

Symptoms of an abdominal aortic aneurysm?

An AAA often results from a weakened area in the aorta that begins to grow and expand much like a balloon. It is sometimes called the “silent killer” because symptoms may only present when the aneurysm is close to bursting. As the AAA grows, you may feel:

  • Back, leg, or abdominal pain that lingers
  • Deep, consistent belly pain
  • Pulsing sensation near your belly button

If your aneurysm bursts, it’s an emergency. Seek medical attention if you feel:

  • Clammy (wet) skin
  • Dizziness
  • Fainting
  • Nausea and vomiting
  • Rapid heartbeat
  • Shortness of breath
  • Sudden, intense pain in your stomach, lower back, or legs

What surgical techniques are used during AAA surgery?

Not every AAA will require surgery. The decision to perform surgery often depends on the size of the aneurysm. How big an aneurysm is can be directly linked to the risk of rupture. Small AAAs (less than 4 cm) may be monitored with interval noninvasive imaging studies.

When surgery is proposed, our vascular team will perform a complete medical history. In conjunction with the clinical presentation, we will offer a solution best tailored to you. There are three commonly offered surgical options for treating AAA:

Endovascular aneurysm repair (EVAR)

Endovascular aneurysm repair (EVAR) is rapidly becoming the gold standard treatment for AAAs, particularly if the shape or anatomy of the aneurysm is considered suitable for repair. This minimally invasive procedure can either be performed completely percutaneously or with small incisions in the groin to access the femoral arteries.

Our vascular surgeons can exclude and reline the abdominal aorta by inserting a specialized endograft and fluoroscopy (continuous X-ray guidance). This prevents aneurysm growth and rupture. Compared to traditional open surgery, EVAR can shorten a patient’s hospital stay and help them return to normal activity more quickly. Most patients leave the hospital in two days.

Complex endovascular aneurysm repair

Fenestrated EVAR or FEVAR is an advanced endovascular repair. This technique is used to treat patients with an AAA located above the kidneys. While the recovery is similar for most patients, the surgery is more involved. It requires specially customized stents to accommodate a patient’s aorta, while ensuring blood flow to the renal arteries and successfully treating the aneurysm. Our experts are the only vascular surgery board-certified surgeons in South Florida who perform this procedure.

Occasionally, a patient’s medical history, clinical presentation, and aortic anatomy may mean a fenestrated EVAR isn’t possible. However, they also are not great open surgery candidates. In these cases, our vascular surgery team provides endovascular alternatives, including ESAR (endosuture aneurysm repair) and chEVAR (chimney graft endovascular repair).

Open surgery

Our vascular team may offer open surgical reconstruction when a patient’s aneurysm anatomy or shape is unfavorable for endovascular repair options or in cases of infected aneurysms. During this traditional surgery, our surgeon will make an incision over the patient’s abdomen to control and replace the diseased portion of the aorta.

The surgeon will sew in a specialized graft to restore appropriate blood flow to the abdominal and lower extremity vessels. The recovery for these open procedures can be longer than endovascular surgical options. However, repeat surveillance imaging following surgery will be less frequent.

What causes an abdominal aortic aneurysm?

Although aneurysms can grow anywhere along the aorta and its branches, most develop in the abdomen. Several factors can contribute to these weakened areas. Conditions that can increase AAA risk include:

  • Atherosclerosis (a buildup of plaque along the walls of your arteries)
  • Tobacco use
  • Cardiovascular disease
  • High blood pressure
  • Infection (rare bacteria or fungi infections can cause AAAs)
  • Trauma that causes arterial wall tears
  • Vasculitis (blood vessel inflammation)

Alongside various health conditions, there are multiple controllable and uncontrollable risk factors that increase the likelihood of developing an AAA. These include:

  • Age: Being over age 65
  • Ethnicity: Historically, white patients are more at risk for developing AAAs than other ethnicities.
  • Family history: Anyone with a family history of AAA should be screened.
  • Sex at birth: AAAs develop more often in men than women. However, women experience more severe AAAs.
  • Tobacco use: Smoking is the biggest risk factor for developing AAA. It weakens the arterial wall, raising the risk of rupture. The longer you smoke, the higher your risk. However, all smokers (past or current) are at risk.

Men and women with a family history of AAA should be screened after ages 55 and 65, respectively. If you have a personal history of smoking, you should undergo an ultrasound screening test between the ages of 65 and 75 at the very latest.

What are the potential side effects of an untreated abdominal aortic aneurysm?

If you think or know you have an AAA, talk with your doctor about your treatment options as soon as possible. Delaying care gives the aneurysm time to grow, and it increases your risk that it will rupture. Additionally, a delay in diagnosis may change your surgical treatment options. As an AAA gets bigger, endovascular repair may not be possible. At that point, open surgical repair may be the only option.

Patients often ask when aneurysms should be repaired. All aneurysms that cause symptoms — pain or rupture — should be repaired as soon as possible. Elective repair may be offered to women with an AAA over 5 cm in size and to men with an AAA greater than 5.5 cm in size. These AAAs have a near-10% chance of bursting each year.

However, the risk of rupture increases exponentially as abdominal aneurysms continue to grow. Patients who present with a ruptured AAA experience severe internal bleeding, and the risk of death is more than 80%.

If you have been diagnosed with an AAA, talking with a board-certified vascular surgeon is important. Our experts are here to help. Please contact our office at 305-243-8272 for an appointment.

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