Treatment - Abdominal aortic aneurysm

The treatment for an abdominal aortic aneurysm (AAA) mostly depends on how big it is and the patients state of health.

Treating an AAA usually means having surgery to replace the damaged Aorta. There are measures you can take to slow the growth of an aneurysm. The major factor in the growth is the pressure within the aneurysm itself.

Your blood pressure should be checked regularly and kept within normal limits. Exercise and avoiding smoking will help reduce your blood pressure. Your GP may recommend medication to control high blood pressure.

AAAs are grouped into 3 sizes:

• small AAA – 3cm to 4.4cm across
• medium AAA – 4.5cm to 5.4cm across
• large AAA – 5cm or more in men and 5.5cm or more across in women

Large AAAs are more likely to burst (rupture). You will usually be recommended surgery to stop this happening.

The risk of a small or medium AAA bursting is much lower. You'll need regular scans to check its size. Making healthy lifestyle changes may help stop it getting bigger.

Ask your doctor if you're not sure what size your aneurysm is.

Surgery is not recommended until the aneurysm is at risk of rupture.

Small and medium AAAs

You might not need treatment if you have a small or medium AAA. This is because the risk of the AAA bursting is smaller than the risk of complications from surgery.

You'll be asked to come back for regular ultrasound scans to check if your AAA is getting bigger.

You'll get a scan:

• every year if you have a small AAA
• every 3 to 6 months if you have a medium AAA

You may need surgery if the scans show that a AAA larger than 4cms has grown by more than 1cm over 12 months. Surgery may also be offered if you have symptoms linked to AAA. These could be a pulsing sensation in your tummy or tummy pain that does not go away.

Lifestyle changes such as eating healthily can reduce the risk of an aneurysm getting bigger.

You can otherwise carry on as normal. Having an AAA may affect things such as driving and getting travel insurance.

Large AAAs

If you have a large AAA, surgery to replace the weakened section of aorta with an artificial aorta is usually recommended. This is because the risk of it bursting is bigger than the risk of complications from surgery.

There are 2 main types of surgery for an AAA:

• endovascular surgery – the tube is inserted into a blood vessel in your groin and then passed up into the aorta
• open surgery – the tube is placed in the aorta through a cut in your tummy

Both techniques are equally good at reducing the risk of an AAA bursting, but each has its own advantages and disadvantages. Talk to your surgeon about which is best for you.

If surgery is not suitable for you, you'll have regular scans to monitor your AAA. You'll be given advice about healthy lifestyle changes. You may also be prescribed medicine to treat high blood pressure or high cholesterol.

Endovascular surgery

In endovascular surgery, a tube (graft) is inserted into a blood vessel in your groin through small cuts made in your skin. It's then guided up into the aneurysm.

This diverts all the blood through the new graft and blocks blood flow into the aneurysm. This operation can be done under general anaesthesia or under spinal/epidural type anaesthesia which completely numbs the lower half of the body.

You'll normally stay in hospital for 2 or 3 days after the operation. It can take a few weeks or months to fully recover.

The advantage of endovascular surgery is a quick recovery time as it avoids a large tummy operation. As with any operation there are possible complications and risks. These will be explained to you by the operating surgical team and anaesthetists.

They can include:

• severe bleeding (haemorrhage)
• blood clot blocking an artery to your leg or legs
• heart attack
• stroke
• wound infections
• chest infection

The risk of complications is generally lower than with open surgery.

A disadvantage of endovascular surgery is that the graft has to be checked regularly after surgery. This is because sometimes the anchorage slips so that the graft moves and there’s leakage around the graft into the aneurysm once more. You may need another operation to fix any problems.

Open surgery

During open surgery, a cut is made in your tummy and your surgeon replaces the affected section of aorta with a graft. This is done under general anaesthetic.

You'll usually stay in hospital for 7 to 10 days after the operation. It will take a few weeks or months to fully recover.

The risk of complications is generally higher than with endovascular surgery. The hospital stay and recovery time is often longer.

Risks of open surgery include:

• a wound infection or infection of the graft
• a blood clot
• severe bleeding (haemorrhage)
• a heart attack or stroke
• erectile dysfunction or ejaculation problems in men

The risk of graft problems is lower than with endovascular surgery. The graft will usually work well for the rest of your life and you will not usually need regular scans to check it.

Treatment for a burst AAA

A burst aneurysm is a medical emergency. It is treated with emergency surgery using the same techniques used for a large aneurysm.

The decision about whether to perform open or endovascular surgery is made by the surgeon carrying out the operation.