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How is an abdominal aortic aneurysm (AAA) treated?

Dr. David W. Drucker, MD
Cardiologist (Heart Specialist)

Patients with abdominal aortic aneurysms that need to be treated have two excellent options. Open surgical repair or endovascular stent graft placement. Open surgery can be very effective and was the standard for many decades. A vascular surgeon or other type of surgeon makes an incision. They find the aneurysm and they put a brand new tube in. This excludes the aneurysm and you normally don't have to worry about it again. An issue with surgical aneurysm repair, is that it is more invasive, requiring an abdominal incision. This may increase the risk of some complications as well as prolong hospitalization and recovery time. In addition, some patients with other medical issues (severe lung disease, advanced age, previous abdominal surgeries, severe cardiac disease) may not be good candidates for open repair.

Endovascular stent graft therapy is a minimally invasive way to treat abdominal aortic aneurysms. Through two small incisions in the groin area or completely percutaneously, the physician can implant a covered stent that lines the inside of the blood vessel. This allows blood to flow through the stent but exclude any more flow into the aneurysm. The nice part about this procedure is that it works well and it’s easier to recover from. Most people spend one or two days in the hospital, return to fully functional more quickly and have lower complication rates. These stents must be monitored for the rest of the patient’s life to ensure that they continue to do their job. The choice between surgery and minimally invasive options should be made after a full discussion of al options with the patient’s physician.

If your abdominal aortic aneurysm (AAA) is small (less than 2 inches across), your doctor may recommend watching and waiting.
  • You'll need tests every 6 months or so to make sure the aneurysm isn't growing.
  • You might take medications to lower your blood pressure and control your cholesterol. You should also make changes to reduce your risk.
If your AAA is large (over 2 inches across) or growing rapidly, it should be repaired. There are two ways to repair an AAA:
  • Abdominal surgery. A large incision (cut) is made in your abdomen. The weakened aorta section is removed and replaced with a tube made of a special synthetic (man-made) material.
  • Endovascular aneurysm repair (EVAR, also called "stent grafting"). In an EVAR procedure, two catheters (tiny tubes) are inserted into an artery in your leg and threaded up through it to the aorta. The catheters are used to place a tube called a stent graft into the aorta at the area of the aneurysm. The stent graft "lines" the aorta like an inner sleeve and stays in place after the procedure. Blood flows through the graft and doesn't press against the aneurysm.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.