Have you ever wondered what would happen if a major artery in your abdomen silently expanded to the point where it could burst at any moment?
An abdominal aortic aneurysm (AAA) is a silent but deadly threat, with a high risk of death if the aneurysm ruptures. The process is silent, with no obvious symptoms until the condition becomes severe.
Surgery is the main treatment when the aneurysm reaches a dangerous size or shows signs of leakage. Timely intervention is vital in preventing catastrophic consequences.
AAA surgery is usually recommended when aneurysm size exceeds 5.5 cm in men.
When Is AAA Surgery Needed?
Surgical treatment of abdominal aortic aneurysms (AAA) is not an arbitrary decision but a strict clinical indication, based on imaging data, size progression and clear clinical manifestations. The risk of aneurysm rupture increases dramatically when the diameter exceeds the physiological threshold, and this requires rapid action to prevent life-threatening consequences.
Aneurysm size is the decisive factor
When the diameter of the aneurysm reaches 5.5 cm in men or 5.0 cm in women, the risk of rupture increases significantly. This milestone is the clinical boundary for surgical indication.
Growth rate warns of risk
An aneurysm that increases by more than 0.5 cm within 6 months is a sign of rapid progression. This change reflects sudden risk and requires early intervention.
Clinical symptoms that warn of danger
Dull pain in the abdomen or back, feeling of a pulsating mass under the skin are the symptoms to point out. These signs indicate that the aneurysm is under pressure or has signs of leakage.
Imaging risk assessment
CT angiography provides detailed information about the morphology, wall of the aneurysm, and risk of rupture. The doctor will conduct a comprehensive assessment to give the most accurate surgical indication.
Types of AAA Surgery
Abdominal aortic aneurysm (AAA) surgery is not only a medical intervention but also a strategic decision, depending on the morphology of the aneurysm, cardiovascular risk and general condition of the patient. The two main methods – open surgery and endovascular intervention – both aim to eliminate the risk of rupture, but the approach is different, each option has its own indications and clinical benefits.
Open Surgical Repair (OSR)
The surgeon makes an incision in the abdomen to directly access the aorta, remove the aneurysm and sew a piece of artificial tube. This technique is suitable for young, healthy patients or when the vascular anatomy is complex. The recovery time is about 6–8 weeks, requiring close postoperative monitoring.
Endovascular Aneurysm Repair (EVAR)
The procedure involves inserting a stent graft into the artery via the femoral artery, inserting it into the aneurysm and separating the blood from the weak wall. EVAR offers a short hospital stay (1–2 days), reduced blood loss, and is suitable for patients at high surgical risk. However, periodic imaging is required to monitor for complications such as endoleak or stent migration.
Preoperative Evaluation and Preparation
Preoperative preparation for AAA surgery is a comprehensive process, not only to determine the possibility of intervention but also to optimize the patient's entire physiological system before entering the decisive surgery. Each step of the assessment acts as a safety filter, to minimize risks and ensure sustainable treatment results.
Intensive diagnostic imaging and testing
A three-dimensional CT angiogram helps the doctor determine the size, location and structure of the aneurysm. Blood tests, electrocardiogram and echocardiogram allow the assessment of coagulation function, liver - kidney and cardiovascular reserve.
Control of internal risk factors
Blood pressure must be stabilized. Patients who smoke are required to stop smoking for at least 4 weeks to improve lung function and reduce the risk of postoperative respiratory complications.
Surgical consultation and agreement on treatment plan
A conversation with a vascular surgeon is an essential step. Patients are clearly explained about the type of surgery, risks, recovery time and commitment to long-term follow-up after surgery.
What to Expect During Surgery
Abdominal aortic aneurysm (AAA) surgery is a tightly controlled procedure that requires close coordination between the anesthesia team, vascular surgeons, and the resuscitation team. Every step in the operating room is precisely planned to minimize risk and maximize the effectiveness of the intervention.
General or regional anesthesia
For open surgery, the patient is given general anesthesia. During EVAR, either spinal anesthesia or general anesthesia can be used, depending on the clinical indication and cardiovascular condition.
Duration of surgery varies by technique
Open surgery usually lasts from 2 to 4 hours, while EVAR only requires about 1 to 2 hours. During this time, hemodynamics are continuously monitored to ensure absolute stability.
Postoperative hospital stay
Patients undergoing EVAR usually only need to stay in the hospital for 1–2 days. With open surgery, hospital recovery time can last from 5 to 10 days, including wound care, cardiopulmonary resuscitation, and early return to mobility.
Recovery After AAA Surgery
The recovery phase after abdominal aortic aneurysm surgery is a directed physiological recovery process, requiring strict compliance from the patient and close clinical supervision from the medical team. The recovery structure is not only the healing of the surgical wound, but also the recovery of the entire vascular, respiratory, motor and psychological systems after major intervention.
Controlled physical activity
Patients are instructed to move early with increasing intensity, starting from walking in the room, progressing to walking in the hallway. Walking helps prevent deep vein thrombosis and supports circulation.
Wound care and medication
The wound needs to be kept dry, clean and monitored daily for early signs of infection. Anticoagulants, blood pressure medications and antibiotics are prescribed according to standard protocols.
Regular follow-up and imaging follow-up
After EVAR, patients are required to undergo regular CT scans or ultrasounds to detect complications such as endoleaks or stent dislocations. Patients who have undergone open surgery also require long-term follow-up to assess graft function.
Risks and Potential Complications
Every surgical procedure for treating an abdominal aortic aneurysm (AAA) carries a spectrum of physiologic complications – from local inflammatory reactions to systemic complications. Understanding and predicting potential risks is fundamental to individualizing treatment and optimizing long-term recovery outcomes.
Common postoperative complications
Hemorrhage, wound infection, acute kidney injury, and deep vein thrombosis are common complications. Patients may experience electrolyte disturbances, respiratory failure, or hemodynamic changes in the early postoperative period.
Specific risks of EVAR
Endoleak – a phenomenon of blood leakage around the stent graft – can lead to re-dilation of the aneurysm. Graft migration results in loss of therapeutic efficacy and requires additional intervention. These complications are often detected during routine imaging.
Significance of Long-Term Follow-Up
Postoperative follow-up helps detect abnormalities early and adjust intervention strategies in a timely manner. Regular follow-up visits, assessment of vascular function, and control of cardiovascular risk factors are essential for long-term management.
Conclusion
Surgical treatment of abdominal aortic aneurysms (AAA) is a proactive intervention to prevent sudden rupture – a situation that can quickly lead to death if not treated promptly. The decision to operate should be based on a comprehensive assessment of the size of the aneurysm, clinical progress and underlying health of the patient.
Coordination between the vascular specialist and the patient plays a decisive role in choosing the appropriate time and method of intervention. Regular postoperative follow-up ensures long-term effectiveness and prevents late complications.
Frequently Asked Questions (FAQs)
- Is AAA surgery dangerous? – AAA surgery always comes with risks such as bleeding, organ damage or cardiovascular complications. However, when properly indicated and performed at a specialized center, the success rate is high.
- What is the difference between EVAR and open surgery? – EVAR is an endovascular method, minimally invasive, quick recovery and suitable for elderly patients. Open surgery is a direct intervention in the artery, requires good physical condition and a longer recovery time.
- Do endovascular stents last forever? – Stents are designed to stay in the artery for life. However, patients need regular monitoring to check the stability of the stent and detect early complications such as endoleak or displacement.
- How long after surgery can they return to work? – With EVAR, patients can return to light work after 2 weeks. Open surgery takes about 6–8 weeks to fully recover. Your doctor will assess your specific condition before allowing you to return to work.
- Will I need to have another operation after a while? – Some patients may need another intervention due to complications such as bleeding or stent migration. Adhering to a regular check-up and imaging schedule helps to detect the problem early and treat it promptly.
