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When a weakened area of a blood vessel expands or bulges to any significant degree, it is called an aneurysm. Such bulges stem from a weakness or defect in the wall of the aorta and tend to grow bigger over time. When aneurysms are located on the part of the aorta located in your abdomen, they are called abdominal aortic aneurysms. The greatest danger is that the aneurysm will burst or rupture, causing uncontrollable bleeding or hemorrhage, which frequently can be fatal. Most aneurysms cause no symptoms and are detected on screening exams or studies performed for other reasons with ultrasound or CT scans.
The risk of rupture is related to the size (diameter) of the aneurysm. Small aneurysms can be safely followed until they grow large enough that the risk of rupture outweighs the risk of surgical repair. If the aneurysm is small and not causing any pain it can be watched over time in what is known as “watchful waiting.”
You may have to return to your doctor every six to 12 months for testing to make sure the aneurysm is not growing. Managing blood pressure and cholesterol during this time is important to try to reduce the rate of enlargement. If you smoke, make every effort to stop as cessation can reduce the aneurysm’s growth rate and reduce the risk of rupture.
It is also important to continue normal activities during watchful waiting and avoid a sedentary lifestyle so you can be in the best possible condition should surgery become necessary.
There are two treatments for correcting an abdominal aortic aneurysm: open surgical repair and minimally invasive endovascular repair (EVAR). At the CardioVascular Institute, the majority of abdominal aortic aneurysms are now treated with endovascular surgery.
The CVI helped pioneer the latest version of endovascular abdominal aortic aneurysm repair — Total Percutaneous AAA Repair — which not only avoids the need for an abdominal incision but also does away with having to cut into the groin. Instead, vascular surgeons make a small puncture in the skin of each side of the groin to gain access to the aneurysm. The vast majority of patients undergoing endovascular abdominal aneurysm repair at the CVI get this newer version of the procedure.
The endovascular approach is associated with a shorter hospital stay and quicker recovery time as well as a lower mortality rate. Patients also benefit from a reduction in postoperative wound infection rates.
Abdominal aortic aneurysms usually require repair when they reach a size when rupture becomes a real risk. This is mostly determined by the size of the aneurysm — about 5.5 cm for a man and 5 cm for a woman. In some cases, repair is needed for symptoms of back or abdominal pain or rapid growth. Factors considered when weighing surgery against endovascular repair include the anatomy of the aneurysm, particularly how close it is to the kidneys. Age, general health, symptoms and any other health issues you may have, particularly heart issues, are also considered.
Almost all patients are considered candidates for Total Percutaneous AAA Repair, regardless of obesity, small arteries, previous groin surgery, previous use of a closure device or arterial calcifications. Those with a separate reason to have groin surgery, such as a CFA (common femoral artery) aneurysm or severe arterial narrowing, would be appropriate for AAA repair through groin entry at the same time.
In general, endovascular repair is particularly advantageous for patients over age 65, those at risk because of other medical conditions and those who have had previous abdominal surgery.
Endovascular and open abdominal aortic aneurysm repair are performed in the operating room. Endovascular aortic aneurysm repair takes place in a special “hybrid operating room” — a traditional operating room equipped with the latest image guidance technology that is only available at a few hospitals worldwide.
If you take aspirin and/or Plavix, continue to do so. Do not stop these medications prior to your procedure.
If you are on blood thinners such as Coumadin (warfarin), Pradaxa (dabigatran), Xarelto (rivaroxaban), or other blood thinners, please call the office at least one week prior to your procedure to discuss the need for stopping this medication.
If you have diabetes and take Metformin (glucophage), please do not take this medication the day of surgery. You will also need to refrain from taking it for two days (48 hours) after the procedure.
If you have diabetes and take insulin: If you take Lantus, take 80 percent of your normal dose the evening prior.
If you take NPH, take half of your normal dose of NPH insulin the morning of the procedure and do not take regular insulin on the morning of your procedure.
If you take Bactrim, please stop it the day before your procedure.
Do not eat or drink anything after midnight the night before your procedure.
Take your usual medication with a small sip of water unless your doctor has told you otherwise.
Do not smoke or drink alcohol for 24 hours before the procedure.
Let your doctor know if you have any of the following symptoms before the procedure: fever, cold, cough, flu-like symptoms, shortness of breath or chest pain.
Park in one of the West Campus parking garages, located at 170 Pilgrim Rd. and 110 Francis St. Valet parking is available in front of the Rosenberg Building on Deaconess Road. Take your garage ticket with you — parking is discounted for patients, family and friends. Of course, family and friends may accompany you and are welcome to stay.
Your surgery will take place in the Rosenberg Building. You will need to check in with a receptionist at the information desk who will announce your arrival to your surgical team. You will wait in the lobby until you are called to go up to the preparation and holding area. The surgical suite is on the 5th floor. There is a family waiting area on the 6th floor; family members or friends are not allowed in the operating room during the procedure.
Please note that because BIDMC is a Level I Trauma center, the need to perform emergency surgery occasionally forces us to change scheduled procedure times without notice.