ABDOMINAL AORTIC ANEURYSM

Why does an AAA develop?

Common risk factors include:

• Increasing age (especially >60 years)

• Male gender

• Smoking (most important risk factor)

• High blood pressure

• High cholesterol

• Family history of aneurysm

• Atherosclerosis (hardening of arteries)

What symptoms does AAA cause?

• Most AAAs cause no symptoms and are detected during scans done for other reasons.

• When symptoms occur, they may include:

  • Pulsating mass in the abdomen

  • Abdominal or back pain

  • Sudden severe pain, dizziness, or collapse (suggests rupture – medical emergency)

How is AAA diagnosed?

• Ultrasound scan – simple and commonly used for screening and follow-up

• CT angiography (CT scan) – gives detailed size, extent, and anatomy; essential for surgical planning

When is surgery needed for AAA?

Surgery is recommended when:

• The aneurysm size is ≥ 5.5 cm in men (≥ 5.0 cm in women)

• The aneurysm is growing rapidly (>0.5 cm in 6 months)

• The patient has symptoms

• There is rupture or impending rupture (emergency surgery)

Small aneurysms (<5 cm) are usually monitored, not immediately operated.

Surgical treatment options for AAA

1. Open Surgical Repair

• The abdomen is opened

• The diseased part of the aorta is replaced with a synthetic graft

• A long-established and durable procedure

Advantages

• Long-term durability

• Suitable for patients with complex anatomy

Disadvantages

• Larger incision

• Longer hospital stay and recovery

• Higher initial surgical stress

2. Endovascular Aneurysm Repair (EVAR)

• A minimally invasive procedure

• A stent-graft is inserted through arteries in the groin

• The graft lines the aorta from inside, excluding the aneurysm

Advantages

• Smaller incisions

• Less pain

• Faster recovery

• Shorter hospital stay

Disadvantages

• Not suitable for all patients

• Requires lifelong imaging follow-up

• Possible need for future procedures

Emergency surgery for ruptured AAA

• Requires immediate life-saving surgery

• Can be open repair or EVAR depending on availability and patient condition

• Mortality remains high despite prompt treatment

Recovery after AAA surgery

• Hospital stay:

  • Open surgery: 7–10 days

  • EVAR: 2–4 days

• Gradual return to normal activities over weeks

• Strict control of blood pressure and lifestyle modification

Follow-up after AAA repair (Very Important)

After EVAR

• Regular lifelong follow-up is mandatory

• CT scan or ultrasound:

  • At 1 month

  • At 6–12 months

  • Annually thereafter

• To detect:

  • Endoleaks (blood leaking around the graft)

  • Graft movement or blockage

  • Increase in aneurysm size

After Open Surgery

• Follow-up is simpler

• Periodic clinical check-ups

• Occasional imaging if needed

• Long-term durability is excellent

Follow-up for patients without surgery (small AAA)

• Regular ultrasound:

  • Every 6–12 months depending on size

• Stop smoking

• Control blood pressure, diabetes, and cholesterol

• Prompt reporting of new pain or symptoms

Long-term outlook

• Elective AAA surgery has excellent outcomes

• Early detection and proper follow-up prevent rupture

• Lifestyle changes and medical control play a major role in long-term success