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Aortic Aneurysm Surgery (open/endovascular stenting)

An aneurysm is an abnormal dilation of the vessel wall. The abnormal swelling can cause symptoms when it grows, leaks or embolises (showering off debris from within the vessel). Whilst any vessel can dilate, most commonly aneurysms form in the abdominal aorta, the iliac, femoral and popliteal arteries. Occasionally aneurysms form in the thoracic aorta and carotid arteries.


The diagnosis is usually made either by clinical examination or by ultra sound examination. CT or MR scanning will give more details about the anatomy of the AAA (Abdominal Aortic Aneurysm).

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Indication for Surgery

The risk of the aneurysm leaking/rupturing has to be weighed up against the risk of surgery itself. In small aneurysms (less than about 55mm) the risk of surgery is usually greater than the risk of observation alone. Repeat ultrasound examinations at 6 monthly or yearly intervals allow the rate of growth to be determined. Over 55mm the risk of rupture is probably greater than the risk of surgery so surgery is usually advocated.

Elective vs Emergency Surgery

The risk an elective surgical repair varies from individual to individual but is usually between 3-7% of a major complication or death. Emergency repair carries a 50% mortality.

Screening for abdominal aortic aneurysms

There is growing evidence that the introduction of a population screening programme (in particular for men) will save lives. Hopefully this will be introduced into the UK shortly.

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Open vs Endovascular Repair

Conventional open surgery on the abdominal aorta was first undertaken in the 1950s. The operation is a well tried and tested procedure with good long term results. Endovascular repair of AAA was first undertaken in the early 1990s. Its attraction is the small scars and rapid recovery from surgery. Unfortunately not all aneuryms are suitable for an endovascular repair and the long term results are less well understood. At C&W CVU we work in close collaboration with our interventional radiologists and aim to offer the most appropriate approach to each individual.

Factors Predisposing to Leak or Rupture of Aneurysm

Diameter of aneurysm
Diastolic blood pressure
Expansion rate
Family history
Chronic lung disease

Open Surgery

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Dacron graft   Top end sewn into position

Dacron graft   Top end sewn into position
    Lower anastomosis complete

    Lower anastomosis complete

Thoracic Aneurysms

Thoracic aneurysms are relative rare. Treatment options are conservative (leave alone), open surgery or endovascular surgery. We work closely with our cardiothoracic colleagues to try to determine the safest approach.

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    8.5 cms thoracic aneurysm with stent in place

8.5 cms thoracic aneurysm with stent in place

Popliteal Aneurysms

Aneurysmal dilatation can occur in any vessel, but more commonly occurs in the femoral (groin) or popliteal (behind the knee) arteries. Repair is advised before it either leaks or embolizies (showers debris).

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    5cm politeal aneurysm with reverse vein graft

5cm popliteal aneurysm with reverse vein graft

Complex visceral artery reconstructions

Occasionally the renal (kidney) or mesenteric (gut) arteries narrow or block. Often the best approach is an endoluminal approach. There are situations when the endoluminal approach is not possible or an open approach is more appropriate. The long saphenous vein (upper thigh) is harvested, reversed and then used as the conduit.

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Right Renal Artery Bypass
Right renal artery bypass (2)

  Aorto-bifem with left renal artery bypass

    Bifurcating jump vein graft from supra coeliac to common hepatic and superior mesenteric artery for mesenteric angina

Managing an abdominal aortic aneurysm, C Imray, 2006 - Click here to view PDF

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