Aortic Aneurysm

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What is aortic disease?

Aortic disease is an abnormlity of the largest blood vessel in the body, the aorta. Diseases such as atherosclerosis (hardened calcified deposits), aneurysms (dilation of the vessel) and dissection (separation in the vessel layers) can occur. The aorta can can also become inflammed due to infection.

Aortic aneurysm

An aortic aneurysm is an abnormal dilation of the aorta, classified as greater than 5 cm. This can lead to rupture and death.

Causes and Risk factors

  • Age
  • Male sex
  • Weight
  • Smoking
  • Hypertension

Symptoms

Aneurysms can have no symptoms (asymtomatic) depending on the severity. Symptoms may include chest or abdomen pain, blood in the stool or urine, difficulty breathing.

Diagnosis

Diagnosis is made using a computed tomography (CT) scan of the body. The physician can visualise the anuerysm on this scan and measure its size.

Treatment

Depending on the size of the anuerysm, a patient may or may not be treated immediately. If there is a concern of rupture then treatment may involve open surgery or a minimally invasive endovascular treatment (catheters inserted through arm or leg arteries). Treatment depends on the severity of the anuerysm, the medical condition of the patient, and the patients anatomy.

Open and endovascular repair of the aneurysm is carried out using a stent graft. This is a fabric covered tube which effectively cuts the aneurysm off from blood circulation.

Figure 1 : Total Volume of Elective AAA repairs in GUH (1995-2007)

Since the foundation of the Western Vascular Institute and the provision of Specialist Services into Galway University Hospital, we have experienced a dramatic rise in the volume of patients treated with AAA1. Before 2001 all AAA repairs were done by open repair. Since 2001, the total volume of AA repairs has increased by 65%. However the additional case-load has been managed by EVAR with a high-turnover rate. The absolute number of open repairs has not increased. (Mean no of open AAA repairs before 2001= 17 vs Mean no. of open AAA repairs from 2001 onwards =28, p=0.140). (Figure 1). A specialised high deliberate practice volume has led to marked improvements in outcomes with open repair.