A Simpler Solution for Abdominal Aortic Aneurysms

When a patient is diagnosed with an abdominal aortic aneurysm (AAA), many envision the large incision and lengthy recovery associated with open heart surgery. For most patients, however, open surgery is a thing of the past. With improved techniques and technology, the majority of AAAs can be fixed through a minimally invasive procedure known as endovascular aneurysm repair (EVAR). And some patients who undergo EVAR at Miami Cardiac & Vascular Institute, part of Baptist Health South Florida, can go home the next day.

There’s other good news about treating aneurysms, too. The less invasive approach is being used more often on complex abdominal aortic aneurysms that have multiple branches or are located in hard-to-reach places.

An aneurysm, or a weak spot in a blood vessel, can form in arteries and veins anywhere, from the brain to the kidneys to the liver. If undetected, it may grow until it bursts. If that occurs in the aorta, which is the largest blood vessel in the body and carries blood from the heart to the limbs and organs, it can cause a life-threatening emergency. Some 200,000 Americans are diagnosed with an AAA each year.

Barry T. Katzen, M.D., chief medical innovation officer for Baptist Health, and founder and chief medical executive of Miami Cardiac & Vascular Institute.

“At Miami Cardiac & Vascular Institute, we pioneered the less invasive approach. We are among the most experienced in treating aneurysms throughout the body. And because we have an integrative team of interventional radiologists and vascular surgeons, we are prepared to do any and all types of procedures and can even create unique solutions for the patient’s specific anatomy,” says Barry T. Katzen, M.D., chief medical innovation officer for Baptist Health and founder and chief medical executive of the Institute.

During EVAR, doctors insert a small catheter into an artery in the groin and thread it through the blood vessel to the aneurysm. They then deploy a stent graft or endograft , usually made of a combination of metal mesh and fabric. When the stent expands, blood flows through it, alleviating the pressure on the artery. The stent graft stays in place permanently.

A ruptured aneurysm requires emergency intervention, but small asymptomatic aneurysms can usually be monitored with regular imaging to follow any growth or change. Before recommending treatment, physicians will consider the size and location of the aneurysm, as well as the age and overall health of the patient.

Aneurysms are often asymptomatic, but that doesn’t mean that there aren’t risk factors that everyone should be aware of, Dr. Katzen says. “Smoking is one of the greatest risk factors. In fact, smoking is not only related to the development of aneurysms, but also to poorer outcomes with treatment or rupture,” he says.

Others at risk include those with high blood pressure, high cholesterol, diabetes and heart disease. If you’re overweight, your risk is also elevated. There is also a very important genetic component, with studies showing an increased risk of up to 25 percent in people with a first-degree relative who has had an abdominal aortic aneurysm. They are more common in men than women.

Patients often ask about their likelihood of developing an aneurysm elsewhere in the body once they have been diagnosed with an abdominal aortic aneurysm. An aneurysm in the popliteal artery (behind the knee) is associated with an AAA about 40 percent of the time, Dr. Katzen says. He was part of a team of doctors who repaired popliteal arteries behind both of Vice President Dick Cheney’s knees in 2005 using the minimally invasive technique. A popliteal aneurysm is less likely to rupture than an aneurysm in the aorta, but it can cause blood clots that lead to amputation of the limb.

Aneurysms in the brain are generally not linked to aneurysms elsewhere. However, patients with fibromuscular dysplasia (FMD) whose disease causes a narrowing in the kidney arteries among other problems, do have a 20 percent risk of having an aneurysm in the brain.

If you feel you are at risk for an abdominal aortic aneurysm, speak to your doctor about screening. The Institute continues to investigate next-generation technology for aneurysm treatment through clinical trials.