AORTIC ANEURYSMS

An aortic aneurysm is an abnormal bulging or ballooning of the aorta — the body's largest artery, which carries blood from the heart down through the chest and abdomen. When the wall of the aorta weakens, it can expand to form an aneurysm. If left untreated, the aneurysm may continue to grow and is at risk of rupturing, which is a life-threatening emergency.

The most common type is an abdominal aortic aneurysm (AAA), which forms in the section of the aorta that runs through the abdomen. Thoracic aortic aneurysms, affecting the portion of the aorta in the chest, are less common.

In the UK, men over 65 are routinely offered AAA screening via the NHS. However, aneurysms can also affect women and younger individuals, particularly those with a family history or connective tissue disorders.

Most aortic aneurysms develop slowly and cause no symptoms, which is why screening and surveillance are so important. When symptoms do occur, they may include:

•    A persistent, deep aching pain in the abdomen, back, or flank
•    A pulsating sensation or lump in the abdomen
•    Unexplained weight loss or loss of appetite

Warning signs of rupture — seek emergency help immediately
A ruptured aortic aneurysm is a surgical emergency with a high mortality rate. Symptoms include sudden, severe pain in the abdomen or back, collapse, and signs of shock. If you suspect a rupture, call 999 immediately.

Risk factors
Factors that increase the risk of developing an aortic aneurysm include smoking (the single most important modifiable risk factor), high blood pressure, high cholesterol, a family history of aortic aneurysm, male sex, and age over 60.

Not all aneurysms require immediate repair. The decision to intervene depends on the size of the aneurysm, its rate of growth, and the patient's overall health. In general, elective repair is recommended when an AAA reaches 5.5cm in diameter or sometimes 5.0cm in women, or when it is growing rapidly.

For smaller aneurysms, a programme of regular ultrasound surveillance is recommended to monitor growth. Professor Zayed provides expert surveillance and timely intervention when the threshold for repair is reached.
 

Endovascular aneurysm repair (EVAR)

EVAR is the minimally invasive approach to aneurysm repair and is now the most commonly performed technique for suitable patients. A fabric-covered metal stent graft is introduced through small incisions in the groin and navigated under X-ray guidance to line the inside of the aneurysm, excluding it from the circulation and preventing rupture. EVAR avoids the need for a large abdominal incision, with shorter hospital stays and faster recovery than open surgery.

Open surgical repair
In cases where the anatomy of the aneurysm is not suited to EVAR — or where endovascular repair is not technically feasible — open surgery remains the definitive treatment. The aneurysm is repaired through an abdominal incision, with a synthetic graft sewn into place. Professor Zayed has extensive experience in aortic surgery, including aortobifemoral and axillobifemoral bypass for associated aortoiliac occlusive disease.