Abdominal aortic aneurysm (AAA) is one of the health issues that is often overlooked because its symptoms are not usually apparent. As a result, some patients do not receive timely diagnosis or treatment. Today, we will introduce you to abdominal aortic aneurysm, including its causes, risk factors, symptom observation, diagnostic tests for surveillance, and treatment options. One of the most effective current treatment technologies is endovascular aortic repair (EVAR), a procedure for repairing the abdominal aortic aneurysm via a catheter.
Abdominal Aortic Aneurysm (AAA)
Abdominal aortic aneurysm (AAA) is a condition where the aorta, the large artery in the abdomen, expands abnormally and bulges out. The main cause of AAA is the degeneration and weakening of the aortic wall. When the aortic wall becomes severely dilated, it can rupture, which is a life-threatening situation that can lead to rapid death.
What Symptoms Should Raise Suspicion for Abdominal Aortic Aneurysm (AAA)?
Abdominal aortic aneurysm (AAA) is often discovered accidentally during a health check-up or when diagnosing another condition through an ultrasound, CT scan, or MRI of the abdomen. This condition usually develops gradually without clear symptoms in the early stages. However, if the aneurysm becomes large or extends significantly, the patient may experience the following symptoms:
• Chronic abdominal or back pain The pain may be sudden or persistent, often described as deep, aching, or sharp. It is most noticeable around the waist and spine area, which may be caused by nearby nerves being compressed or irritated by the enlarged aorta.
• Pulsating mass in the abdomen A pulsating mass that can be felt in the abdomen, particularly around the middle of the abdomen or near the navel, may indicate the presence of the aneurysm, as it beats in sync with the heart.
In cases where the aneurysm is severe or close to rupturing, it may cause sudden and intense symptoms, including severe pain, a burning sensation in the abdomen, rapid heart rate, sweating, dizziness, and fainting due to low blood pressure. These symptoms are signs of shock from blood loss, which can be fatal. Therefore, individuals at risk or experiencing suspicious symptoms should promptly seek medical attention for proper diagnosis and to identify the underlying cause.
Who is at Risk for Abdominal Aortic Aneurysm (AAA)?
• Men are at higher risk than women (4-6 times more likely).
• Individuals aged 65 and older, as the blood vessels naturally degenerate with age.
• People with atherosclerosis or plaque buildup in the arteries, caused by the accumulation of fat and calcium on the artery walls, which makes the arteries lose flexibility and become weakened. This is a primary risk factor for the condition.
• Those with high blood pressure continuously, as this puts extra pressure on the arterial walls.
• Individuals with a family history of AAA.
• Smokers or those exposed to second-hand smoke regularly, as smoking leads to inflammation and accelerated degeneration of the artery walls.
• People with connective tissue disorders, such as Marfan syndrome or Ehlers-Danlos syndrome, which cause the blood vessel walls to be fragile and more prone to expansion.
• Individuals who have had a syphilis infection, bacterial infections, or fungal infections, though these are less common causes.
Treatment for Abdominal Aortic Aneurysm (AAA)
For patients with small aneurysms and mild symptoms, doctors typically recommend close monitoring through regular ultrasound or CT scans. Blood pressure, cholesterol, and blood sugar levels should be kept within healthy ranges. Smoking should be avoided, and lifestyle changes such as exercise and weight management are encouraged.
If the aneurysm is larger than 5-5.5 cm or has expanded to more than twice the size of a normal aorta, or if the patient has additional conditions that make the blood vessels fragile, or if complications such as blood leakage into the veins in the abdomen occur, doctors may consider surgery. Currently, one of the most effective treatments is Endovascular Aortic Repair (EVAR), a procedure where the aneurysm is repaired using a catheter. EVAR has several advantages over traditional open surgery, offering good treatment outcomes and high safety.
Endovascular Aortic Repair (EVAR)
EVAR (Endovascular Aortic Repair) is a technique used to treat abdominal aortic aneurysms or ruptures by inserting a synthetic, blood-impermeable stent graft through the blood vessels, accessed via the groin, instead of performing open surgery. The procedure involves the following steps:
1. Anesthesia: The patient is given general anesthesia to ensure they remain pain-free during the procedure.
2. Accessing the Artery After cleaning the groin area, which is the easiest access point for the arteries, the doctor will make a small incision to access the femoral artery and insert a catheter.
3. Stent Graft Insertion The catheter is used to guide the stent graft (a flexible, strong tube) into place. X-rays or angiography are used to confirm the correct positioning of the stent graft.
4. Stent Expansion Once properly positioned, the stent is expanded. This helps to support the weakened arterial wall and directs blood flow through the stent instead of the bulging portion of the aorta, reducing the pressure on the aneurysm and minimizing the risk of rupture.
5. Final Check After confirming that the stent is correctly placed and there is no blood leakage from the aneurysm, the catheter is removed, and the incision in the groin is closed.
6. Recovery The patient is then monitored in a recovery room for potential complications and to ensure a stable recovery.
EVAR is a minimally invasive option compared to open surgery, with quicker recovery times and lower risks for the patient.
Advantages of Endovascular Aortic Repair (EVAR)
• Smaller Incisions, Less Pain The procedure involves small incisions, causing less pain and avoiding large abdominal cuts as seen in open surgery.
• Minimal Blood Loss There is less blood loss during the procedure, which reduces the need for blood transfusions.
• Quick Recovery The recovery time is fast, with the patient typically staying in the hospital for just 1-2 days. Afterwards, they can resume normal activities within 1-2 weeks at home.
• Reduced Risk of Complications EVAR lowers the risk of complications from general anesthesia and infections that may occur with larger, open surgeries. This makes it a minimally invasive procedure, ideal for elderly patients or those with other conditions like heart disease, diabetes, or lung problems.
• Durability The results of EVAR are comparable to open surgery in terms of long-term durability.
Limitations of Endovascular Aortic Repair (EVAR)
• Not Suitable for Complex Vascular Structures EVAR is not recommended for patients with complicated vascular structures, severely narrowed or kinked arteries, as it may be difficult to place the stent graft properly.
• Need for Ongoing Monitoring After the surgery, patients must undergo regular follow-up exams, such as CT scans or ultrasounds, to ensure that the stent graft remains in place and is not leaking. If the stent graft shifts or deteriorates, which occurs in approximately 5-10% of patients within 1-5 years after surgery, blood may leak back into the aneurysm site (known as an Endoleak), increasing the risk of rupture. If the stent graft shifts significantly, additional procedures, such as placing a supplemental stent or repositioning the stent graft, may be necessary to prevent serious complications.
Phyathai 2 Hospital recognizes the importance of regular health check-ups and offers a wide range of diagnostic tools and treatment techniques that meet international standards. The hospital aims to meet the individual needs of each patient through a service model called Value Health Care. This allows patients to choose the treatment approach that suits them, whether it’s close monitoring or treatment through minimally invasive procedures like Endovascular Aortic Repair (EVAR). This technique offers a quicker recovery time, reduces the risk of complications compared to open surgery, and is less invasive.
Additionally, patients can opt for personalized services, such as care from private nurses, tailored meals, rooms to their preference, and transportation services. For those with questions about the most appropriate treatment options, consultations with specialists are available at the Heart Center of Phyathai 2 Hospital. This ensures that all treatments are managed with high efficiency, excellent care, and provide the best value in terms of both quality and medical outcomes.