VASCULAR SOLUTIONS - Vascular and Endovascular Surgeons Treating Peripheral Vascular Disease in Cleveland, Ohio

Vascular Solutions

How are AAAs found?

Most of the time it is an incidental finding during a routine medical visit, or most commonly when a test, such as an ultrasound or Cat Scan (CT) is performed for an unrelated reason.

Very occasionally, a patient may discover the AAA by becoming aware of an abnormal pulsating mass in the center of his/her abdomen.

Because AAA often remain symptom free and undetected for years, some of them, unfortunately are diagnosed when they rupture. This is why all living siblings of a patient with ruptured AAA, should obtain an abdominal ultrasound to ensure they do not have one.

Why are AAA important/dangerous?

AAA can slowly grow to a considerable size without causing any symptoms at all. By enlarging, an aneurysm carries an increased risk of rupture (bursting) without warning, leading to catastrophic bleeding and a very high risk of death (in some reports the risk exceeds 90% of patients die). It is compared to over inflating a balloon to the point it will eventually burst.

The fact that large AAAs can remain undetected, until they suddenly rupture is what makes them so potentially dangerous.

Aneurysms are repaired to prevent rupture. The mortality from a ruptured AAA ranges in the medical literature from 50 to 90%. The mortality from elective repair in the medical literature is about 2-3%. Vascular Solutions has an excellent mortality rate much less than 2%.

Small aneurysms (smaller than 5 cm) do not require repair unless they become symptomatic. Aneurysms without symptoms (asymptomatic) can often be monitored with careful surveillance using either repeated ultrasound or CT scans. Incremental increasing size is often as important as the absolute size.

Larger aneurysms (>5cm) have an increased risk of rupture. Patients with aneurysms that are larger than 5 cm should be considered for elective repair of the AAA. Consideration for repair must be balanced with a patient's medical history, physical exam, anatomic information of the AAA, as well as several other parameters. This information must be considered to arrive at an appropriate means to manage the AAA including the type of repair (i.e.. open vs. endovascular).

Do all AAA need repair?

Although this is a significant or major operation, it is a very safe one relative to the morbidity and mortality of operation. Vascular Solutions physicians take great lengths to ensure patient safety. Before embarking with repair of AAA all patients are evaluated by a cardiologist (heart specialist). Also an arteriogram is often performed to provide us with a road map to repairing the AAA and to avoid surprises in the operating room. Our average success rate is better than 98% with infrarenal AAAs.

How safe is surgery?

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