ABDOMINAL AORTIC ANEURYSM:
Aneurysm is abnormal enlargement (ballooning) and weakening of one of the arteries in the body. If aneurysm involves the big artery in your abdomen, it is called abdominal aortic aneurysm. This is a serious condition however treatment is possible.

How Can Aneurysms Be Discovered?
Aneurysms usually do not cause any symptoms however they are discovered incidentally during diagnostic tests for other problems or your doctor may feel the aneurysm during a physical examination.

Aneurysms maybe related to several underlying factors:

• Hereditary (if someone in your family had an aneurysm)
• Age: this is usually a disease of the older age
• Tobacco use
• High blood pressure
• High cholesterol

Next Step:
Your doctors and vascular surgeons will discuss the treatment options and will be able to recommend the best option for you. Size of the aneurysm is the most important factors while making a decision for treatment. Aneurysms reaching a certain size carry a rupture risk. However, close observation maybe recommended for smaller aneurysms since rupture risk may not be as high. Surgery maybe required if an aneurysm enlarges during the follow-up period.

What is an Abdominal Aortic Aneurysm?
Blood vessels in the body are similar to water pipes. Pipes carrying clean blood are called arteries. Abdominal aortic aneurysm occurs in the biggest artery in the body, the abdominal aorta. Abdominal aorta divides into two at the level of the belly button and carries blood to the lower part of the body as well as the lower extremities. The blood vessels to your kidneys also originate from the abdominal aorta.

Why do aneurysms occur?
Aneurysms occur due to weakening of the wall of the arteries. The weakened arterial wall bulges out and starts to enlarge, just like a balloon. The wall of the artery will get progressively thinner and weaker. This may eventually lead to rupture of the weakened aortic wall.

There are certain conditions that may lead to weakening of the aorta:
These are accumulation of cholesterol and calcium which may lead to loss of elasticity of the aortic wall and decrease its resistance to high pressures, Smoking, High blood pressure and certain infections and inflammatory conditions of the aorta.

Doctor Survey:
Your surgeon will ask detailed questions about your health as well as your family history since there are genetic factors in the etiology of the abdominal aortic aneurysms. Aneurysms maybe completely silent or they are sometimes associated with pain in the lower back and abdomen.

Ultrasound:
Your doctor may order several diagnostic tests. These tests are important to evaluate the size and the growth rate of the aneurysm. Ultrasound is the initial screening test to evaluate the size of the blood vessels using acoustic waves. Ultrasound is non-invasive and painless test. You might be bale to also see your aneurysm on the TV screen while the test is being performed.

Tomography ve MRI:
A computerized tomography provides more detailed examination of the aneurysm. Serial X-rays of the aneurysm are obtained by the CT machine and reconstructed to yield an accurate size and shape and extent of the aneurysm. A magnetic resonance imaging test provides imaging of the body using radio waves. Intravenous dye is utilized in both CT and MR angiography to facilitate visualization of the large vessels.

Arteriography:
Arteriogram is an invasive technique where intravenous contrast-dye in injected into the blood vessel and X rays are taken to delineate the anatomy of the aneurysm. It is now less commonly performed due to availability of angiogram capabilities of CT and MR.

Doctor Controls:
The size of the aneurysm is the most important factor determining the treatment strategy. Smaller aneurysms have a smaller chance of rupture therefore your doctor might recommend to follow the aneurysm with serial CT scans or ultrasound examinations for a period of time. This will determine whether the aneurysm has is growing and rate of enlargement if it has grown. These tests are usually repeated every 6 months and you will be required to see your doctor at the scheduled intervals during the follow-up. Notify your doctor immediately if you develop pain in your lower back or abdomen during this period.

Life Style Modifications:
Certain life style modifications might help you to prepare for the surgery / intervention and may slow the rate of aneurysm growth. These are to quit smoking, control high blood pressure and adapting a healthier diet.

Decision of Surgery:
Surgical intervention may be required for enlarging aneurysms. Although there are certain risks for every surgical procedure, your doctor will compare the risk of aneurysm rupture with the risk of surgery and will recommend surgery if indicated.

Preparation for Surgery:
If your surgeon has advised surgical treatment, you should quit smoking immediately if you are a smoker. Do not forget to mention your complete medication list and do not drink or eat anything after midnight on the day of surgery unless recommended otherwise.

Anesthesia:
The anesthesiologist may recommend one of the several forms of anesthesia for the procedure. These are general anesthesia, epidural anesthesia and spinal anesthesia.

CERTAIN RISKS AND POSSIBLE COMPLICATIONS:
Abdominal aortic aneurysm surgery has certain risks and possible complications. However the probability of these risks is much less than the risk of rupture.

• Infection
• Blockages of the arteries in the legs and feet due to emboli from the aneurysm
• Kidney problems
• Ischemia of the large bowel
• Problems witn erection and ejaculation (in males)
• Paraplegia (paralysis below the waist)
• Heart problems
• Possible complications with endovascular surgery if this technique has been used

SURGERY:
The enlarged and weakened part of the aorta is replaced with an artificial tube (graft) at the time of surgery. This tube graft is made out of very strong and durable material. If the procedure is performed with the open technique, graft is sawn into place and if the procedure is done with the endovascular technique the graft is secured into the aorta using special hooks to the normal aorta above and below the aneurysm. The surgical team will recommend open or endovascular surgery depending on the size and location of the aneurysm as well as your general health status.

Open Procedure:
The open procedure is done through your abdomen. The length and location of the incisions can be different for every patient for open procedures. Surgeons will open the aneurysm, clean the debris and blood clots and cholesterol and fatty deposits and suture the graft to the normal aorta above and below the aneurysm.

Endovascular Surgery:
Endovascular surgery is performed through incisions in one or both of your groins. The new blood vessel (the graft) is advanced through the blood vessels in your groin to the aorta (hence endo-vascular) and the diseased aneurismal part of the aorta is excluded from the circulation.

AFTER THE SURGERY:
The patient will be taken to the intensive care unit after the procedure where he/she will stay for one or two days. Average length of stay after this procedure is 5-7 days after the open procedure and 2-3 days after endovascular procedures. You might have tubes to drain the bladder and the stomach after the procedure. The medications are administered through the intravenous route for a few days after the surgery. Your doctors will provide pain medications and you will be kept as pain free as possible after the procedure. If you have an epidural catheter, this will stop your pain for a few days. Early ambulation (walking) after the procedure will speed recovery.

Discharge:
Your surgeons will go over the findings of surgery with you in detail prior to discharge and give you instructions to follow after you are discharged home. Try not to exhaust yourself too much after discharge. It may take a few months to recover completely after the open procedure. You should be able to return to normal activities in a few weeks after the endovascular repair.

Take your discharge medications as instructed by your doctor. Do not wait the pain get worse before you take your pain medicine. Wash the surgery site with warm water and soap when instructed to shower. Do not scrub the incision. It is expected to have loose stools or constipation after the procedure. Light meals will help to regulate your bowel function. It is also normal to feel weak and tired for a few weeks after surgery. Staying active and light exercise will speed up your recovery.

Call your doctor:

• If you have redness and drainage from the wounds
• Fever over 38 degrees Centigrade
• Severe back, groin or abdominal pain

A Healthier Life:
Several life style modifications will help you live a longer life and may help with regression of the atherosclerosis. Cessation of tobacco use will lead to better control of your high blood pressure, improve wound healing and is the first step for a healthier life.

Controling Blood Pressure:
High blood pressure will place extra stress on your heart. It also leads to weakening and calcification of the arteries. Strict control of hypertension will prevent progression of the degeneration in the arteries. It is very important to follow your doctor’s instructions regarding control of high blood pressure.

Right Diet:
Excess salt will lead to high blood pressure. Excess fat and high cholesterol diet will accelerate atherosclerosis. Pay close attention to the labels of the food products.

A Healthier Diet:
A healthier diet should include lots of fruits and vegetables. Choose the low fat dairy products. It is also important to lower the total amount of dietary fat intake by choosing low fat and non-fat food products. Try to use salt substitutes instead of salt when possible. Switch to baked or broiled foods rather then fried foods.

What Else You Can Do:
It is also important to make regular exercise a part of your daily life.