While not truly a “treatment” for abdominal aortic aneurysms (“AAA”), most of the patients seen at The Cardiovascular Care Group with this condition are managed by simply watching the AAA! Most AAAs do not need to be operated upon and, therefore, simply monitoring them on a regular basis is the best “therapy! ”As arteries enlarge in diameter (aneurysm), the wall weakens thus predisposing the artery to rupture. The goal of monitoring the AAA size is to intervene before the artery ruptures! Several factors are important in determining when to intervene with the absolute size being only one of the determining factors. The rate of growth is important as are the other medical conditions a patient might have in addition to their overall health and age. All of these factors must be taken into consideration as the discussion between the physician and the patient ensues.
Stent Graft (EndoVascular Aneurysm Repair—EVAR)
The use of endovascular technology has markedly altered the management of AAA disease. Through a puncture in each groin, the aneurysm can be fixed using a metal-supported piece of fabric that eliminates the pressure on the wall of the aneurysm thereby reducing the chance of it expanding and rupturing. The device is passed through the arteries—one from each groin—and an “inverted-Y” configuration is generally used to “build a tunnel through the aneurysm.” The stent graft is placed from a point above the top of the AAA to points below it. As noted above, this creates a tunnel within the aneurysm for the blood to flow though.
Depending on the anatomy, a small cut may be required in one or both groins to facilitate passage of the stent graft. A thin wire is passed up the artery from each groin. Over the wire, the stent grafts are passed from each side and “married” to form the “inverted-Y” bringing the blood from the aorta into both legs. Typically, the procedure requires 60 – 90 minutes to complete and the stay in the hospital is 24 hours. This, of course, varies between patients based on the complexity of their anatomy and the other illnesses the patient may have. Local anesthesia can be used as can general depending on the patient specifics.
We, at The Cardiovascular Care Group, were among the first in the state of New Jersey to place endovascular grafts for AAA disease. We have placed over 1,000 grafts since then with excellent results. It is important for patients to commit to follow-up after the EVAR is completed to make certain that no problems develop.