Treatment of Abdominal Aortic Aneurysm

The current treatment options for aortic aneurysms include observation coupled with smoking cessation, open surgical repair using a fabric tube and endovascular stent graft repair of the aorta (EVAR).

Observation

If an aortic aneurysm is small and not causing symptoms, the treating physician may want to perform a scan such as ultrasound, CT or MRI every 6 to 12 months to assess changes in the size or shape of the aneurysm. Patients are also encouraged to stop smoking. This kind of monitoring is common for aneurysms that are less than 5cm in diameter.

If the aneurysm is large or rapidly expanding or causing symptoms, it will require prompt repair to prevent rupture and possible death. The two repair options are open surgery and endovascular repair.

Open Surgery

open surgeryOpen surgical repair of an abdominal aortic aneurysm takes place in an operating room under general anesthesia. The surgeon typically makes a large midline incision from below the breastbone to below the belly button. The aorta is exposed and clamped off during the procedure. The surgeon places a long tube made of cloth-like material and sews it in with stitches. After releasing the clamp, blood flows from healthy aorta through the tube and into healthy aorta again. Blood no longer flows into or pressurizes the aneurysm.

Surgery for aortic aneurysm repair may take 2 to 4 hours. Most patients recover in the ICU for several days after the surgery and remain in the hospital for several more days.

To proceed with surgery, your physician must determine that the risk of having this surgery is smaller than the risk of aneurysm rupture. All options should be considered before choosing a treatment.

Endovascular Aneurysm Repair (EVAR)

evarIn the 1990’s, a new technique for treating aneurysms was developed using a graft inserted through the femoral arteries. This technique is called Endovascular Aneurysm Repair (EVAR). EVAR is significantly less invasive than open surgery and is associated with a lower mortality rate. In addition, patients recover faster, leave the ICU and the hospital sooner, and return to activities of normal daily life more quickly. Consequently, EVAR has become the gold standard for treatment of AAA disease requiring treatment.

With EVAR, the delivery catheter is inserted into the femoral artery and positioned in the aorta in the area of the aneurysm. The catheters are used to deliver a stent graft (or endograft) in the aorta. The endograft creates a conduit that directs blood away from the aneurysm and relieves the pressure in the aneursym. EVAR has several benefits over open surgery for AAA repair:

  • The mortality rate is 6 times lower
  • Recovery time in the ICU is 1 day compared to 4 days
  • Hospital stays average 3 days compared to 7 days

Anatomical Limitation

Unfortunately, over 40% of patients who require AAA repair have aortic anatomy that is unsuitable for EVAR graft placement and proper anchoring. Typically these patients are excluded from EVAR due to branch arteries near the aneurysm or aortic angulation in the proximal anchor zone of the endograft. These patients are subsequently sent to open surgery with all the disadvantages listed above.

Furthermore, many of the AAA patients who do undergo EVAR are treated sub-optimally by having endografts forced into aortic locations not recommended by the graft manufacturers. These aortic locations often cannot support an effective and durable result, leading to higher incidence of complications and mortality rates.

The development of the investigational AortaFit™ System may offer a personalized solution for patients with anatomic limitations that have excluded them from benefitting from EVAR or that have prevented optimal EVAR results.

 
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