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Elective surgical treatment of an abdominal aortic aneurysm (AAA) is considered when:

• Aneurysm is expanding slowly and can be followed through imaging at regular intervals
• Aneurysm is symptomatic
• Fusiform aneurysm (tubular shaped) where the circumference of the aorta is distended up to 5 cm. in diameter
• Saccular aneurysm (outpouching from one section of the aorta) that is up to twice the diameter of the unaffected section of the abdominal aortic aneurysm

In the general population, the best predictor of life expectancy in the presence of an abdominal aortic aneurysm is age and presence of other medical conditions. These considerations are part of the decision analysis of whether to undergo surgical repair of an abdominal aortic aneurysm and if so, which procedure is most appropriate. Because the risks associated with surgery are considerable, surgery may be delayed until the aneurysm has grown to 5.5 cm. or, possibly, when the risk of complications exceeds the risk of surgery. The goal, however, is to repair high-risk aneurysms before complications develop.

There are several factors that an individual with an abdominal aortic aneurysm should consider and discuss with their health-care provider before making a decision of whether or not to undergo elective surgery for AAA repair. These factors include:

• Risk of rupture
• Risk of mortality during the elective surgery
• Life expectancy following surgery

• Comorbid (co-existing) medical conditions

  • coronary artery disease (e.g., atherosclerosis)
  • other cardiac diseases (e.g., arrhythmias, congestive heart failure)
  • peripheral vascular disease
  • hypertension (high blood pressure)
  • pulmonary disease (e.g., COPD)
  • impaired kidney function
  • morbid obesity

• Patient preference

Patients with coronary artery disease pose a special surgical challenge for elective repair of abdominal aortic aneurysms because myocardial infarction (heart attack) is a major risk factor for perioperative mortality (up to 30 days post surgery) in these patients. Some doctors estimate that 50% to 60% of cases of perioperative mortality are due to cardiovascular or cardiac related events and, therefore, the following factors should be evaluated prior to undergoing elective AAA repair surgery:

• Electrocardiogram (EKG)
• History of cardiovascular disease
• Cardiac stress test

If uncontrolled hypertension is present, it must be treated at the earliest opportunity since high blood pressure increases the risk of potential rupture of an abdominal aortic aneurysm. In some circumstances, corrective cardiac surgery may be performed before repair of the abdominal aortic aneurysm which reduces postoperative mortality rate due to cardiac complications.

One of the most important criteria for deciding which surgical procedure to undergo for elective surgical repair of an abdominal aortic aneurysm (AAA) is the experience of the surgeon performing the repair as well as the experience and training of the hospital staff in assisting and treating patients undergoing each type of surgery. The aspect of surgical experience is highly associated with morbidity and mortality rates and warrants careful attention by the patient before making any decisions.

There are two surgical options available for the repair of abdominal aortic aneurysms:

• open repair
• endovascular repair (EVAR)

Open Repair

This is an invasive surgical procedure in which an incision is made through the abdomen to expose the abdominal aorta and gain access to the aneurysm. A prosthetic tube-like graft (stent-graft), usually composed of a synthetic material (e.g., Dacron) is surgically sewn into place in order to repair the aneurysm. Following surgery, the individual is in the intensive care unit usually for up to 3 days and remains in the hospital on the average of 5-10 days. Recovery time on the average is 2-3 months depending on age and other factors.