The abdominal section of the aorta, as the major supplier of blood to the lower body, carries blood at an high pressure. A bulging weak spot in the abdominal aorta, called an abdominal aortic aneurysm, can rupture and cause fatal internal bleeding. If your doctor detects an aneurysm, she may recommend surgical repair to remove the risk of rupture. The surgery can either remove the aneurysm or reinforce the site.
Significance
The National Heart, Lung and Blood Institute reports that 14,000 Americans die each year from aortic aneurysms and that 75 percent of aortic aneurysms occur in the abdominal segment. Most of the deaths occur when the aneurysm ruptures. Emergency surgery can fix a ruptured aneurysm, but the survival rate is low, and many people die before even reaching the hospital, according to the Mayo Clinic.
Significance
The Mayo Clinic recommends elective surgery for an abdominal aortic aneurysm that is 5.5 cm (2.2 inches) or more in diameter, is growing quickly (more the 0.5 cm in six months), or painful and leaking blood. The risk for rupture increases with the size of the aneurysm. According to the Merck manual, the risk rises to between 5 percent to 10 percent in a year for an aneurysm of 5.0 cm to 5.9 cm, and from 30 percent to 50 percent for one that is 8 cm or greater. Ruptures have a very high fatality rate, so with even a 5 percent chance of a rupture, surgery becomes a reasonable option.
Open Repair
A surgeon makes a large incision in the abdomen to reach the site of the aneurysm in an open repair procedure. She will cut out the weakened section of the bulging abdominal aorta and replace it with a synthetic tube made of Dacron or Teflon. The graft is stitched securely in place.
Endovascular Repair
A less invasive option, endovascular repair, reinforces the site of the aneurysm rather than removing and replacing it. The surgeon threads a catheter containing a stent graft of woven material strengthened with metal mesh up through a major artery in the thigh to the site of the aneurysm. The graft is released, expanded and fastened in place by small hooks or pins. Placement of the stent relieves the pounding pressure of blood flow and eliminates the risk of rupture.
Considerations
Endovascular repair with a stent graft is less invasive than open surgery, requires less time in the hospital and allows for a much faster recovery. Reinforcement with a stent graft has a lower risk of death or complications than open repair, according to the Mayo Clinic. However, the size or location of your aneurysm might prevent you from using this option.
The possibility of post-surgical complications of a stent graft, such as clotting, kinking or a leak at the site or "migration" of the graft away from the site, require more frequent check-ups than after open repair.
