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Abdominal Aortic Aneurysms

  • An AAA is an increase in aortic diameter by greater than 50% of normal
  • Usually regarded as aortic diameter of greater than 3 cm diameter
  • More prevalent in elderly men
  • Male : female ratio is 4:1
  • Risk factors - hypertension, peripheral vascular disease, family history
  • Accounts for 2% male deaths above the age of 55 years
  • 3000 elective and 1,500 emergency operations in Maharashtra each year
  • Mortality of emergency operation is greater than 50%
  • Mortality of elective surgery is less than 5%
  • Selection of patients for operation depends on risk of operation vs. risk of rupture
Abdominal Aortic Aneurysms

Natural history


Clinical features

Indication for operation

  • Rupture
  • Symptomatic aneurysm
  • Rapid expansion
  • Asymptomatic > 6 cm - exact lower limit controversial

Pre-operative investigation

  • Need to determine
    • Extent of aneurysm
    • Fitness for operation
  • Ultrasound, CT Scan
  • Determines - aneurysm size, relation to renal arteries, involvement of iliac vessels
  • Most significant post op morbidity and mortality related to cardiac disease
  • If pre-operative symptoms of cardiac disease need cardiological opinion
  • May need thallium scan or cardiac catheterisation
  • Cardiac revascularisation required in up to 10% patients

Endovascular aneurysm repair


  • Endovascular repair achieved by transfemoral or transiliac placement of prosthetic graft
  • Proximal and distal cuffs / stents anchor graft
  • Exclude aneurysm from circulation
  • Three main types of graft
    • Aorto-aortic
    • Bifurcated aorto-iliac
    • Aorto-uniiliac graft with femoro-femoral crossover and contralateral iliac occlusion
  • Use of technique depends on aneurysm morphology
  • Aneurysm morphology is best assessed with spiral CT
  • Only ~40% of aneurysms suitable for this type of repair
  • Aorto-aortic grafts less frequently used due to high complication rate
  • Successful stenting associated with reduced aneurysm expansion
  • Still has 1% per year risk of aneurysm rupture


Dr. Pankaj Patel a vascular surgeon has expertise in peripheral vascular diseases, varicose veins and deep vein thrombosis

Open surgery for Aneurysm repair nowadays is done only on young and fit patients.