Thoracic Aortic Aneurysm Repair

What is an Abdominal Aortic Aneurysm?

An abdominal aortic aneurysm, also called AAA or triple A, is a bulging, weakened area in the wall of the aorta (the largest artery in the body), resulting in an abnormal widening or ballooning greater than 50 percent of the normal diameter (width). The aorta extends upward from the top of the left ventricle of the heart in the chest area (ascending thoracic aorta), then curves like a candy cane (aortic arch) downward through the chest area (descending thoracic aorta) into the abdomen (abdominal aorta). The aorta delivers oxygenated blood pumped from the heart to the rest of the body.

The most common location of arterial aneurysm formation is the abdominal aorta, specifically, the segment of the abdominal aorta below the kidneys. An abdominal aneurysm located below the kidneys is called an infrarenal aneurysm. An aneurysm can be characterized by its location, shape, and cause.

The shape of an aneurysm is described as being fusiform or saccular which helps to identify a true aneurysm. The more common fusiform shaped aneurysm bulges or balloons out on all sides of the aorta. A saccular shaped aneurysm bulges or balloons out only on one side.

A pseudoaneurysm, or false aneurysm, is an enlargement of only the outer layer of the blood vessel wall. A false aneurysm may be the result of a prior surgery or trauma. Sometimes, a tear can occur on the inside layer of the vessel resulting in blood filling in between the layers of the blood vessel wall creating a pseudoaneurysm.

The aorta is under constant pressure as blood is ejected from the heart. With each heart beat, the walls of the aorta distend (expand) and then recoil (spring back), exerting continual pressure or stress on the already weakened aneurysm wall. Therefore, there is a potential for rupture (bursting) or dissection (separation of the layers of the aortic wall) of the aorta, which may cause life-threatening hemorrhage (uncontrolled bleeding) and, potentially, death. The larger the aneurysm becomes, the greater the risk of rupture.

Abdominal Aortic Aneurysm Treatment

Traditional Open Repair of AAA

Traditional surgical treatment for an abdominal aortic aneurysm (AAA) is performed with general anesthesia and is accomplished with a surgical incision in the abdomen or flank. The aneurysm is opened and replaced with an artificial tube that is sewn into the normal artery above and below the aneurysm. Vascular surgeons at Robert Wood Johnson University Hospital (RWJUH) perform approximately 50 open AAA repairs yearly.

Minimally Invasive AAA Repair

Endovascular aneurysm repair (EVAR) is a minimally-invasive procedure that is also used in the treatment of abdominal aortic aneurysms. In an EVAR, a manufactured device known as a stent-graft is deployed under x-ray guidance inside the aneurysm to exclude it from the circulation. Several different devices are used for these repairs at the institution, including the Gore Excluder, Cook Zenith, and the Medtronic Talent devices. RWJUH surgeons are experts in selecting and using the appropriate device for your specific aneurysm.

The major advantages of endovascular repair typically include:

  • Avoidance of major abdominal surgery.
  • Shorter length of stay.
  • Faster recovery. Most patients stay overnight in the hospital and are back to normal activity within a week.

The number of patients being treated with an endovascular stent graft is growing rapidly each year. At the present time, over 100 endovascular repairs are performed yearly at RWJUH.

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