Abdominal Aortic Aneurysm (AAA) is a localized dilation of the aorta in the abdominal portion, exceeding its normal diameter by more than 50%. AAA is rare in people under 50, but its prevalence increases significantly with age. It affects approximately 5-10% of men between the ages of 65 and 79 and is three times more common in men. Significant recognized risk factors include cigarette smoking (risk 2 to 3 times higher in smokers than in nonsmokers) and hypertension.
Most abdominal aortic aneurysms are asymptomatic; diagnosis is often incidental and can be made through a medical examination (detection of an abdominal “mass” pulsating with each heartbeat) or through diagnostic tests performed for other reasons (ultrasound, X-ray, CT scan).
The natural progression of an aneurysm is a progressive increase in diameter, and it often becomes symptomatic due to rupture, a dramatic event that results in the patient’s death in over 80% of cases.
Aneurysms do not always require surgical repair. Since the risk of rupture increases proportionally to size and growth rate, elective surgery is currently indicated for aneurysms ≥5.5 cm in diameter. For aneurysms of smaller diameter, a case-by-case evaluation is necessary, although a wait-and-see approach with periodic ultrasound checks seems generally preferable.
However, surgery is certainly indicated in the presence of rapid growth (>1.0 cm per year) or morphological features indicating an increased risk of rupture. Furthermore, treatment is always indicated if the aneurysm causes symptoms (abdominal and/or lumbar pain, signs of compression of surrounding structures, etc.). In the presence of a ruptured or rupturing aneurysm, urgent surgery is absolutely necessary.
Currently, the following treatment options are available for AAA:
Traditional surgery: This procedure involves replacing the aneurysmal aorta with a synthetic prosthesis through a surgical incision in the abdomen. It represents the most traditional approach for treating this condition because it yields good results and its long-term validity and limitations are well-known. However, this procedure is associated with cardiac, cerebrovascular, or renal complications that can lead to death, with an incidence that increases proportionally with increasing risk factors (advanced age, compromised cardiac, respiratory, cerebral, or renal systems).
Traditional open surgery performed electively has a 30-day mortality rate of approximately 5-6%, while emergency surgical repair has a mortality rate of approximately 50%.
Endovascular treatment: This involves the placement, under radiological guidance, of an endoprosthesis within the aorta, introduced through the femoral or iliac arteries. Endovascular treatment is certainly less traumatic for the patient than traditional surgery; however, stent placement cannot always be performed because it requires certain characteristics of the shape of the aneurysm or the vessels used to introduce the stent. There is also the risk of bleeding from incomplete sealing between the device and the aortic wall, and the risk of stent dislodgement.
Endovascular treatment appears to have a lower short-term mortality rate than open surgery, although some studies have not shown this difference in “high-risk” groups. However, it is associated with worse long-term outcomes (complications, reoperations), and to date there is no conclusive evidence supporting its preferential use.
Your trusted doctor will address your concerns and guide you towards an informed choice of treatment. Contact him or her for all the information you need for your health needs.
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