Abdominal Aortic Aneurysm

The abdominal aortic aneurysm is a mostly asymptomatic extension of the main artery in the abdomen. Without precursors, the abdominal aortic aneurysm can spontaneously burst (so-called rupture). This creates a life-threatening situation that requires immediate vascular surgery. Despite modern treatment options, the chance of survival in this emergency is low at less than 20%.

Why is the abdominal aortic aneurysm dangerous?

The abdominal aortic aneurysm has a variable risk of rupture depending on the maximum diameter of the vasodilation (rupture of the wall). While small abdominal aortic aneurysm can usually be controlled under 5-5.5cm, we recommend invasive therapy of the abdominal aortic aneurysm from 5-5.5 cm.

It is now known that rupture frequency has decreased. This is related to the improvement of drug treatment, v.a. but by the decreasing nicotine consumption.

While the risk of rupture is very low with a maximum diameter of less than 5cm, the exponential increase will follow. Therefore, the indication for invasive treatment is generally provided from 5 cm in size.

Considering a longer period of time over 5 years, even with a small abdominal aortic aneurysm less than 5 cm, a rupture frequency of more than 10% occurs. Therefore, in case of an abdominal aortic aneurysm between 4 and 5cm regular control is necessary in order not to miss the time of the necessary treatment.

Every year more than 2,000 men and women in Germany die from the rupture of an abdominal aortic aneurysm. The high mortality rate of the rupture results from the high blood loss, so that many patients no longer reach a suitable clinic for the treatment of the abdominal aortic aneurysm. Even those who still go to hospital have a survival probability of 50-60%.

Why does not the abdominal aortic aneurysm in the majority of complaints, although it can be very large?

The abdominal aortic aneurysm does not hurt, because it comes very slowly, usually over decades, gradually to this expansion. Only a rapid growth over days or hours can be perceived as a pain, this is then called symptomatic abdominal aortic aneurysm. The rupture of the wall (rupture) is also felt as a pain, but then it is already very dangerous, as it then leads to heavy blood leakage from the abdominal aortic aneurysm.

It is therefore important to discover the abdominal aortic aneurysm in good time. Only then will we be able to carry out an individual treatment tailored to the patient. In the majority of cases we are minimally invasive, i. we use state-of-the-art catheter techniques to eliminate the abdominal aortic aneurysm.

Who gets an abdominal aortic extension?

Known risk factors for the development of an abdominal aortic aneurysm are v.a. smoking, high blood pressure, increased blood lipids and a familial predisposition.

The risk factor smoking is the most significant, as it can be influenced by the patient himself. The elimination of further nicotine consumption leads to a reduction in the risk of further growth of the abdominal aortic aneurysm. Likewise, the smoking waiver leads to a lower risk of bursting of the diseased abdominal aorta. In particular, female smokers benefit the most from the smoking waiver.

What can the person affected do about it?

Non-smoking, optimization of high blood pressure and blood lipids are the first measures that make sense. At best, this slows down the rate of growth of the abdominal aortic aneurysm, and at the same time has positive effects on the cardiovascular function and the capacity of the organism.

The forms of treatment of the abdominal aortic aneurysm include:

• Conservative treatment (treatment of risk factors, prescription of ASA and statin)
• Stent treatment (EVAR = endovascular aneurysm repair)
• Vascular surgery (OAR = open aneurysm repair)

The abdominal aortic aneurysm is usually the result of many years of existing arteriosclerosis (calcification of the arteries) on the basis of typical risk factors (hypertension, smoking, lipid metabolism disorders, diabetes mellitus, hereditary factors). The most dangerous complication of the abdominal aortic aneurysm is the rupture of the diseased vessel wall with severe blood loss. The probability of survival in this situation is low at 20% and only possible with a timely operation. The risk of rupture is essentially influenced by the diameter of the abdominal aortic aneurysm.