Different types of aneurysms call for different types of repairs
When a blood vessel weakens, a balloonlike dilation called an aneurysm sometimes develops. This happens most often in the abdominal section of the aorta, the largest blood vessel in the body.
If an abdominal aortic aneurysm ruptures, it can be deadly, so learning whether you have an aneurysm and seeking treatment are important.
Medicare pays for screenings for people who are at increased risk for what‘s known in medical shorthand as AAA, says Michael Costanza, MD, an Upstate professor of surgery specializing in vascular and endovascular services. That includes people age 65 to 75 with a family history of aneurysms, and men who are, or were, smokers. Screening involves a painless ultrasound that provides doctors with images of the blood vessels.
Costanza says the size of an aneurysms helps determine its treatment. “As the aneurysm gets bigger, the stress on the wall of the artery increases. When it increases too much, it would obviously break,” he says. “We would like to repair all aneurysms before they get to that breaking point.”
Small aneurysms can be monitored without treatment, but aneurysms that are larger than 5¼ centimeters in diameter are recommended for repair, Costanza says.
Repair originally meant a surgeon opened a patient‘s abdomen, clamped the aorta above and below the aneurysm, and then replaced the ballooned area by sewing an artificial blood vessel in its place. That‘s still an option for a minority of patients.
Endovascular repair is the predominant method of repair today. Introduced in the late 1990s, endovascular repair eliminates the abdominal incision, instead using a needle puncture into a large vessel of the leg. Surgeons use X-ray guidance to pass a wire through the vessel and deploy a fabric-covered metallic stent to the area of the aneurysm. The stent reinforces the vessel without removing the aneurysm.
Some patients have aneurysms that are located too close to their kidneys for using regular stents. In those cases, Costanza offers a custom-made fenestrated endograft, a stent made with built-in openings for the kidney arteries.
“The fenestrated endograft is a much more involved procedure, but it‘s still all done through needle punctures. The patients still go home very quickly after surgery,” Costanza says.
He continues to see aneurysm patients every year, after they have recovered from their repair. This allows the doctor to monitor the integrity of the repair, and to be on the lookout for the development of any new aneurysms.
To schedule your screening, contact Upstate vascular services at 315-464-1800 or 315-492-5881.
Abdominal aortic aneurysms are:
- more common in older men than in women, by a 3- or 4-to-1 ratio, but as women live longer, their rates of AAA are climbing.
- responsible for the deaths of 30,000 Americans per year and are the 10th leading cause of death among older men.
- typically located in the abdominal space between the lower breastbone and belly button.
- likely triggered by environmental factors, such as smoking, although they are thought to have a genetic component.
This article appears in the fall 2018 issue of Upstate Health magazine. Click here for a radio/podcast with Michael Costanza, MD, where he discusses abdominal aortic aneurysms.