An aortic aneurysm is an enlargement of the aorta located on one of its 5 segments:
Thoracic aorta: ascending portion Thoracic aorta: horizontal portion Thoracic aorta: descending portion Supra-renal abdominal aorta (above the start of renal arteries)
The aortic aneurysm affects 6 to 7% of the overall population but there is a clear predominance toward men.
Mostly, the abdominal aortic aneurysm (AAA) is not responsible for any symptom. It is often found by accident, through a radiological examination carried out for another pathology:
Doppler Ultrasound for a venous disease of lower limbs’ check-up Abdominal Ultrasound Abdominal or lumbar Scanner for another pathology
Age (generally as of 60) Atherosclerosis (related to cardiovascular risk factors: tobacco, arterial hypertension, cholesterol…) Genetical factors (even though the genetic marker hasn’t been identified yet)
There are several types of examinations to diagnose the abdominal aortic aneurysm:
The aortic Ultrasound is a simple exam that allows to diagnose the abdominal aortic aneurysm and to identify its size The aortic scanner allows to study more precisely the aneurysm, its dimensions and its expansion The arteriography is no more indispensable
The treatment is only envisaged when the abdominal aortic aneurysm exceeds 50mm and/or in case of abdominal or lumbar pains.
If the aneurysm’s size doesn’t justify the need of a treatment, a biannual or annual surveillance by ultrasound must be carried out. The choice and frequency of this examination depends on the size or morphology of the aneurysm.
Endovascular
The endovascular treatment has become the reference and first-line treatment if the conditions are in place.
It is a radio-surgical procedure – generally performed under general anesthetic – and consists in putting an endoprosthesis inside the aneurysm and securing it with stents.
This intervention only requires 2 small incisions in the groin area.
The endovascular treatment requires a very strict follow-up by scanner or Doppler Ultrasound in order to monitor the aneurysm’s exclusion and to make sure there are no endoleaks. The follow-up is biannual during the first 2 years, and then annual. Some endoleaks require a complementary treatment.
Conventional
The conventional surgical treatment consists in replacing the affected aorta by a prosthesis that is sewn after the abdomen has been opened (laparotomy).
The immediate outcomes require a few day long stay in resuscitation – as the complications’ rate is higher than the endoprosthesis – but the follow-up is more simple because there is no possible endoleaks.