ABC of Vascular Disease

Aortic Aneurysm

1. What is an aortic aneurysm?
An aortic aneurysm is a swelling of the main artery in the abdomen that is called the aorta. The aorta carries blood from the heart to the internal organs and legs and is normally about 2.5 cm (1 inch) in diameter.

2. What causes an aortic aneurysm?
Arteries have elastic walls and pulsate in time with the beat of the heart. Over many years the wear-and tear on the wall of an artery can cause it to weaken. If this happens the artery will increase in size because of the blood pressure inside. If the artery expands to more than twice its normal size it is called an aneurysm. Aortic aneurysms are most common in men over 60 years old. Men are more likely to have an aortic aneurysm if their father or grandfather had the same condition.

3. How do you diagnose an aortic aneurysm?
Many aortic aneurysms do not cause any symptoms and are only diagnosed during examinations or tests for other conditions. You can look for aortic aneurysms deliberately and this is called screening (Aortic Screening). An examination of the abdomen by an experienced doctor is usually all that is required to diagnose an aortic aneurysm. The exact size of an aortic aneurysm can be measured quite easily using an ultrasound machine. More accurate measurements and pictures of the aneurysm may be obtained using a computed tomography (CT) machine. Knowing the size and extent of the aortic aneurysm is important in the planning of any treatment.

4. What will happen if I have an aortic aneurysm and I do nothing about it?
An aortic aneurysm will slowly increase in size. The bigger an aortic aneurysm gets the more likely the wall of the aorta will fail and the blood will leak out (haemorrhage). A leaking aortic aneurysm is a very serious, life-threatening situation and one in ten people survive this complication. The only chance of survival is an emergency operation but many patients do not reach a vascular surgeon in time!

5. What treatment is required for an aortic aneurysm?
An operation to replace the damaged aorta is the only effective treatment that will prevent the aneurysm from leaking. Once an aneurysm has increased to more than 5.5 cm in diameter then the risk of a leak becomes significant and surgery should be considered. The operation involves replacing the affected part of the aorta with an artificial, woven, plastic bypass graft. The operation to repair an aortic aneurysm is a major undertaking and also carries significant risks. If you have an aneurysm less than 5.5 cm then it is actually safer to monitor the size and growth of the aneurysm than to operate too early.

6. What will happen if I need an operation on my aortic aneurysm?
The operation should be done by a qualified vascular surgeon who specialises in this type of surgery and requires a full (general) anaesthetic. During the operation the aorta is exposed through an incision in the tummy and the damaged part replaced with an arterial graft. After the operation it is usual to spend some time in the intensive care unit for close monitoring and the average stay in hospital is about 10 days. Major surgery like this does carry the risk of complications and your surgeon will discuss these issues with you before you sign the consent form. (See Aortic Aneurysm Repair)

7. How long does it take to recover?
A major operation like this takes weeks to months to recover from fully, even in fit people. It is normal to lose between 1 and 2 stones in weight and this weight is only put back on slowly over several months. During this time you can expect to suffer from "lack of energy" and it is sensible to get plenty of rest to give the body the best chance to recover. Good diet and increasing amounts of exercise also help to speed recovery.

8. Can the aneurysm come back?
The good news is that 95% of people have no major problems with the surgery and the likelihood of serious problems arising after successful surgery is low. The arterial graft cannot develop an aneurysm and after surgery you should be able to forget about the problem.

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