Home | Venous Surgery | Carotid Surgery | Aneurysm Surgery | | Sympathectomy | Vascular Reconstructions | General Surgery | ANEURYSMAL DISEASE Also see the page on endovascular aneurysm repair. ARTERIAL ANEURYSMS An arterial aneurysm is an abnormal dilatation (ballooning) of an artery caused by a weakness in the wall of the artery. The commonest cause of weakening of the wall is atherosclerosis - hardening of the arteries. Generally an artery is called aneurysmal when the it increases to twice it's normal size. Any artery in the body can develop an aneurysm but for some reason some arteries are more commonly affected than others. In particular the main artery in the abdomen, the aorta is commonly affected, so are the main arteries in the pelvis - the iliac arteries, in the thigh - the femoral arteries, and the arteries behind the knee - the popliteal arteries. The main risks of aneurysms are either that they burst leading to life-threatening bleeding or they block, cutting off the blood supply to the limbs. Aneurysms are more common in people over the age of 60. They are more common in people who have high blood pressure and/or smoke and aneurysms can run in families, particularly brothers because men are more commonly affected than women. ABDOMINAL AORTIC ANEURYSM (AAA) An Abdominal Aortic Aneurysm (AAA for short) is an abnormal dilatation (ballooning) of the main artery in the body - the aorta. The aorta is the main artery that carries blood away from the heart and all other arteries which supply blood to the head, limbs and body organs come from the aorta. The part of the aorta below the kidney arteries and above the pelvic (iliac) arteries is particularly prone to become aneurysmal. Diagnosis of AAA - The majority of AAA cause no symptoms and are discovered by chance. An routine examination by a doctor or an ultrasound scan performed for some other reason may pick up the presence of an aneurysm. Alternatively some patients may notice an abnormal pulsation in the abdomen. In some parts of the country screening for aneurysms has been established. Investigation of AAA - the majority of AAA can be diagnosed by a simple ultrasound scan which also provides an accurate measurement of size. The risk of rupture of AAA is related to size. AAA bigger than 5.5cm in diameter are at risk of rupture and require surgical repair. Smaller aneurysms are monitored with ultrasound scans every 3-6 months and surgery is only considered if they increase in size or start to cause pain or other symptoms. When an aneurysm requires surgical repair, other investigations are arranged including a CT body scan which provides accurate anatomical information regarding the aneurysm so the operation can be planned in more detail. Other investigations to measure the function of the heart, lungs and kidneys may also be arranged as surgery tends to put a strain on these organs. Treatment of AAA - surgical repair of AAA is a major operation requiring 7-10 days in hospital. An incision is made in the abdomen and normal aorta above and below the aneurysm is dissected and blood flow through the aneurysm is stopped by the application of vascular clamps. The aneurysmal section of the aorta is then replaced by sewing in a tube of special vascular graft material. Blood flow is restored and the abdomen closed. Commonly, patients recover from aneurysm surgery in the intensive therapy unit (ITU). Clamping of the aorta in order to repair the aneurysm, temporarily cuts off the blood supply to the lower half of the body and puts a strain on the heart, lungs and kidneys. The function of these organs needs to be monitored very carefully and appropriate treatment given if required. Heart, kidney and lung failure can all occur but are usually treatable. Sometimes the circulation to the legs can become blocked and further operations to restore the circulation is required. Bleeding from the repaired aorta can occur. Overall the incidence of major complications is in the region of 5% but is increased in those patients with pre-existing disease. Other complications include erectile dysfunction in men, graft infection, wound infection, limb ischaemia etc. Recovery - most people are ready for discharge from hospital within 7-10 days but if complications occur the stay is longer. I tend to warn people that it will take at least 6 weeks to feel as well as they did the night before surgery. The good news is that once you have recovered you can return to normal activity and a normal life-expectancy. The practice of medicine and surgery is not an exact science and reputable practitioners cannot properly guarantee results either expressed or implied. These procedures are highly advanced and discussion about them (including risks and benefits) should be with your specialist.