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“I
have nothing
but good things to say about Dr. Larson and his staff. They are all very
friendly. I have had five operations in nine months and I’m feeling really
good now.”
—Joyce |
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An aneurysm is an enlargement of an artery that occurs
when the wall of the artery becomes weakened, allowing the pressure
within the artery to stretch out the wall. The characteristic finding on
exam is a pulsating mass. As an aneurysm increases in size, the wall
becomes thinner and weaker and the risk of rupture increases. Aneurysms
can occur in any artery, but the most common site is the aorta in the
back of the abdomen, next to the spine. Abdominal aortic aneurysms are
found in approximately 5% of people over the age of sixty.
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Abdominal aortic aneurysms can be found on exam, but
often they’re first discovered on an abdominal ultrasound or CT scan.
They tend to enlarge over time, and once they're larger than 5 cm (or if
they're growing quickly), they should be repairedbecause the risk of rupture increases
dramatically at that point. Ruptured aneurysms are dangerous because
roughly half the patients die of complications, even when emergency
surgery is successful in repairing the rupture.
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Aneurysms are treated in two ways: traditional surgery
or endovascular surgery. In either case, the weak and dilated wall is replaced with a synthetic graft in an operation
that takes 2 - 4 hours. Traditional surgery is performed from either the
left side (a retroperitoneal approach) or straight through the front of
the abdomen. Whenever possible, I use a retroperitoneal approach because
I've found that patients do better after the surgery and they have
less pain, they are eating sooner, and they usually have a shorter
hospital stay.
Endovascular surgery for abdominal aortic aneurysms is a relatively
recent development. In this approach, a 'stent graft' is placed into the
aorta from a smaller incision in both groins. While an endovascular
repair is the least invasive method to fix an aneurysm, only about half
of patients are able to have this type of repair (because of strict
anatomic guidelines for placement of the stent graft).
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| Traditional surgery for aneurysm repair is generally
very
successful. When
the surgery is performed electively (before a rupture), the survival is
over 95% -- this is compared to a 50% survival at best with ruptured aneurysms.
After the surgery, you’ll be in the ICU for at least a day or two, and
be ready for home approximately in a week. I like using the retroperitoneal approach because it’s less invasive—patients have a
quicker return to full function and go home sooner.
Endovascular
surgery is also usually successful. With this approach, patients often
only need two days in the hospital before going home. Because stent
grafts are not sewn into place (as in traditional surgery), there is a
small chance over time they could move within the artery. CT scans are
required every 6 - 12 months to check the position of the graft, and
approximately 15% of patients require another procedure later on to
stabilize the graft.
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If you're over 60 and have any vascular disease or high
blood pressure, ask your doctor to order an ultrasound to check for an
aneurysm (most insurance companies and Medicare will pay for the test).
If you have an abdominal aortic aneurysm, have it examined by ultrasound
every 6 - 12 months. If the aneurysm becomes 5 cm or larger (or
increases in size more than 0.5 cm in six months), talk to your doctor or a surgeon about having it repaired.
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