Treatment of AAA is very specific. Some general guidelines for treating abdominal aortic aneurysms are:
A small-sized aneurysm
In case of a patient having a small abdominal aortic aneurysm — about 1.6 inches, or 4 centimetres (cm), in diameter or smaller — and without symptoms, the doctor may suggest a watch-and-wait (observation) approach, rather than surgery. Surgery, in general, isn’t needed for small aneurysms because the risk of surgery likely outweighs the risk of rupture. If a patient chooses the observation approach, the doctor will monitor an aneurysm with periodic ultrasounds, usually every six to 12 months and encourage the patient to report immediately if there is abdominal tenderness or back pain — potential signs of a dissection.
A medium-sized aneurysm
The size of a medium aneurysm is between 1.6 and 2.1 inches (4 and 5.3 cm). How the risks of surgery versus waiting for stack up in the case of a medium-sized abdominal aortic aneurysm, is unclear. The benefits and risks of waiting versus surgery will need to be discussed with the doctor and then an informed decision is made with the help of the doctor. In the case of watchful waiting, an ultrasound will be needed every six to 12 months to monitor the aneurysm size.
Large, fast-growing or a leaking aneurysm
Surgery is generally required in cases of an aneurysm that is large (larger than 2.2 inches, or 5.6 cm) or growing rapidly (grows more than 0.5 cm in six months). Additionally, a leaking, tender or a painful aneurysm requires treatment.
For abdominal aortic aneurysms, two types of surgeries are available:
- Open-abdominal surgery is done to repair an abdominal aortic aneurysm. The surgery involves removing the damaged section of the aorta and replacing it with a synthetic tube (graft), which is sewn into place. This is done by opening the abdomen under the naked eye. It generally takes a month or so to recover from this type of surgery.
- Endovascular surgery is a less invasive procedure. This type of surgery is sometimes used to repair an aneurysm. In this procedure, doctors attach a synthetic graft to the end of a thin tube (catheter) that’s inserted through an artery in the leg and threaded up into the aorta. A woven tube covered by a metal mesh support — called as a graft – is placed at the site of an aneurysm and fastened in place with small hooks or pins. The purpose of placing a graft is to reinforce the weakened section of the aorta to prevent rupture of an aneurysm.
Patients undergoing endovascular surgery recover faster than those people who have undergone an open-abdominal surgery. But, due to more propensity of leakage from endovascular graft, follow-up appointments are more frequent. Follow-up ultrasounds are generally done every six months for the first year, and then once a year after that. Survival, in the long run, is similar for both endovascular surgery and open surgery.
Various factors will decide the treatment options for an aneurysm. These include a location of an aneurysm, patient’s age, kidney function and other conditions that may increase the risk of surgery or endovascular repair.
Lifestyle measures are the best approach to prevent an aortic aneurysm as they keep the blood vessels as healthy as possible. That means taking these steps:
- Quit smoking and chewing tobacco.
- Maintain a healthy blood pressure.
- Exercise regularly.
- Reduce the intake of cholesterol and fat in your diet.
In case somebody has any of the risk factors for an aortic aneurysm, it is very important to talk to the doctor. If you are at risk, your doctor may recommend additional measures. These include medications to lower blood pressure and relieve stress on weakened arteries.