Abdominal Aortic Aneurysms
By Joseph Metcalf, IV, M.D.
Dr. Joseph Metcalf
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A new type of graft is revolutionizing treatment and significantly improving the recovery period for people who need surgery to repair an abdominal aortic aneurysm.
Q. What is an abdominal aortic aneurysm?
A. The aorta, which the largest artery in the body, runs through the chest and carries oxygen-rich blood from the heart to the abdomen, pelvic area, and legs. When it reaches the abdomen, it is called the “abdominal aorta.” A weakness in the artery wall can cause an aneurysm, or bulge, that may burst and result in serious internal bleeding or blood clots.
Q. How serious is this condition?
A. More than 15,000 Americans die as the result of ruptured aneurysms of this type every year. Early diagnosis and treatment can prevent many deaths.
Q. How are abdominal aortic aneurysms detected?
A. Doctors can feel an aneurysm by physically examining most patients or by ordering an ultrasound or CT scan. When the patient is obese, diagnosis is much more difficult.
Q. How have abdominal aortic aneurysms traditionally been treated?
A. Surgery for this condition was introduced nearly 50 years ago. The standard open procedure entails a very large incision that runs the length of the abdomen, which gives surgeons access to the weakened section of the aorta. Patients receive general anesthesia, stay in the intensive care unit for several days, experience considerable blood loss and pain, and are hospitalized from four days to two weeks.
Q. How is the new surgery different?
A. Specially trained surgeons make two incisions in the groin and insert a catheter than contains an endovascular stent graft. The graft, which is made of fabric and wire mesh, is placed inside the weakened part of the aorta. It provides support and redirects the blood flow from the aneurysm to the graft. The surgeon uses real-time x-rays to make certain the graft is positioned correctly.
Surgeons also can treat smaller aneurysms in arteries to the kidneys, legs, or other areas with a stent graft.
Q. What makes the new surgery “revolutionary”?
A. Surgeons are able to repair the largest artery in the body through small incisions, and most patients go home after an overnight stay in the hospital. The patient experiences much less pain and blood loss, and recovery is much faster.
Q. Who is a candidate for the new surgery?
A. Surgeons make a decision about which type of surgery is appropriate on a case-by-case basis. The decision is based, in part, on the results of an arteriogram and an ultrasound ordered before surgery. An arteriogram is an x-ray of blood vessels, which become visible after the patient is injected with a contrast solution.
About the Author: Joseph Metcalf, IV, M.D., is a board-certified
surgeon on the staff of Methodist Medical Center of Oak Ridge, where he
practices general and vascular surgery. He is associated with Oak Ridge
Surgeons and is a member of the MMC Wound Treatment Center staff. Dr.
Metcalf earned his medical degree from Emory University in Atlanta and
completed a general surgery residency at the University of Mississippi
in Jackson. He is board certified in general surgery and has received
specialized training in the new, minimally invasive surgery to repair
abdominal aortic aneurysms. He is a fellow of the American College of
Surgeons and a member of the American Medical Association.