Abdominal Aortic Aneurysm can be life-threatening, if not detected early

The aorta is the main blood vessel that supplies blood to whole body by its various branches. Abdominal aorta is peculiar in the sense that it supplies blood to both kidneys and intestine along with lower limbs. Sometimes, wall of abdominal aorta become weaken and get stretched and dilated leading to a disease entity known as “Abdominal Aortic Aneurysm (AAA). AAA is common in elderly of more than 60 years of age, and exclusively in chronic smokers. It is more common in men than women. An abdominal aorta of more than 3 cm in dimension is significant and needs a medical attention. Any size above >5.5cm needs urgent attention and treatment for AAA.

Though most of AAA patients are asymptomatic and be diagnosed by ultrasound screening of elderly population or diagnosed incidentally during evaluation of other diseases, symptomatic patients also do have non-specific symptoms like chronic abdominal pain, flank pain or chronic back pain. A large sized AAA may rupture spontaneously, and if not treated immediately, it can be life threating. An ultrasound screening can reduce the risk of rupture through early detection, appropriate monitoring and treatment. The common risk factors for AAA are advanced age, smoking, hypertension, increase cholesterol and family history of AAA.

Open surgical repair used to be standard treatment for AAA, however less invasive stent based Endo-Vascular Aortic aneurysm Repair (EVAR) has evolved in last two decades for treatment of selected cases of TAA. EVAR has the advantage of less operative time and shorter hospital stay, reduced early post procedure morbidity and mortality.  

Dr Rajesh Vijayvergiya, Additional professor Cardiology commented that Department of Cardiology had started the EVAR program for AAA repair from year 2010, and had performed about 10 such cases till date with successful outcome. Dr Rajesh commented that EVAR is a less invasive procedure with a reduced morbidity and mortality, lesser duration of hospital stay and equivalent long-term outcome to open surgical repair in selected patients. He stressed that EVAR procedures require a closed collaboration and co-ordination with other speciality such as cardiac surgery, vascular surgery, anaesthesia and radiology department. Professor Mukut Minz and his team from department of Transplant surgery has continuously supported the program since beginning.  He commented that certain patients’ needs a hybrid approach, where a vascular surgeon has to pitch in for a bypass graft to renal or mesenteric arteries. Dr Minz commented that the first unique patient which was treated in year 2010 with EVAR was a post renal transplant patient, who had an additional surgical bypass graft to mesenteric artery prior to EVAR as a hybrid procedure. This particular patient is still doing well at 5-years of follow-up. Dr Rajesh commented that EVAR is a technically skilful procedure which requires a multi-speciality approach at a tertiary care centre. It is relatively economical at a centre like PGI in comparison to non-public sectors.