How long can you live with a ruptured abdominal aortic aneurysm without surgery

The treatment for an abdominal aortic aneurysm (AAA) mostly depends on how big it is.

AAAs are grouped into 3 sizes:

small AAA – 3cm to 4.4cm across
medium AAA – 4.5cm to 5.4cm across
large AAA – 5.5cm or more across

Large AAAs are more likely to burst (rupture), so surgery to stop this happening is usually recommended.

The risk of a small or medium AAA bursting is much lower, so you'll normally be advised to have regular scans to check its size and make healthy lifestyle changes to help stop it getting bigger.

Ask your doctor if you're not sure what size your aneurysm is.

You might not need treatment if you have a small or medium AAA. This is because the risk of the AAA bursting is smaller than the risk of complications from surgery.

You'll be asked to come back for regular ultrasound scans to check if your aneurysm is getting bigger.

Scans are done:

every year if you have a small AAA
every 3 months if you have a medium AAA

Surgery may be offered if the scans show that a AAA larger than 4cms has grown by more than 1cm over 12 months. Surgery may also be offered if you have symptoms linked to AAA, such as a pulsing sensation in your tummy or tummy pain that does not go away.

You'll also be told about lifestyle changes that can help reduce the risk of an aneurysm getting bigger, such as eating healthily.

Read more about how to stop an aneurysm growing.

You can otherwise carry on as normal, although having an AAA may have some implications for things such as driving and getting travel insurance.

Read some frequently asked questions about AAAs for more information.

If you have a large AAA, surgery to strengthen it with a piece of manmade tubing (a graft) is usually recommended because the risk of it bursting is bigger than the risk of complications from surgery.

There are 2 main types of surgery for an AAA:

endovascular surgery – the graft is inserted into a blood vessel in your groin and then carefully passed up into the aorta
open surgery – the graft is placed in the aorta through a cut in your tummy

Both techniques are equally good at reducing the risk of an AAA bursting, but each has its own advantages and disadvantages. Talk to your surgeon about which is best for you.

If surgery is not suitable for you, you'll have regular scans to monitor your aneurysm and be given advice about healthy lifestyle changes. You may also be prescribed medicine to help stop the aneurysm bursting.

Endovascular surgery

In endovascular surgery, a graft is inserted into a blood vessel in your groin through small cuts made in your skin. It's then carefully guided up into the aneurysm.

This is usually done under general anaesthetic, where you're asleep.

You'll normally stay in hospital for 2 or 3 days after the operation, and it can take a few weeks or months to fully recover.

The risk of complications is generally lower than with open surgery, and the hospital stay and recovery time is often shorter.

Risks of endovascular surgery include:

the graft leaking or slipping out of position – you'll have regular scans to check for this, and may need another operation to fix any problems
a wound infection or infection of the graft
heavy bleeding from your groin
a blood clot, heart attack or stroke

This video shows what happens when you have endovascular surgery for an abdominal aortic aneurysm.

During open surgery, a cut is made in your tummy and your surgeon replaces the affected section of aorta with a graft. This is done under general anaesthetic.

You'll usually stay in hospital for 7 to 10 days after the operation, and it will take a few weeks or months to fully recover.

The risk of complications is generally higher than with endovascular surgery, and the hospital stay and recovery time is often longer.

Risks of open surgery include:

The risk of graft problems is lower than with endovascular surgery. The graft will usually work well for the rest of your life and you will not usually need regular scans to check it.

This animation explains what happens when you have open surgery for an abdominal aortic aneurysm.

A burst aneurysm is treated with emergency surgery using the same techniques used for a large aneurysm.

The decision about whether to perform open or endovascular surgery is made by the surgeon carrying out the operation.

Page last reviewed: 21 May 2020
Next review due: 21 May 2023

Long-term survival for patients undergoing surgical repair of intact abdominal aortic aneurysms has improved in recent decades, according to a Swedish study reported in Circulation: Journal of the American Heart Association.

An abdominal aortic aneurysm is a bulge in the main artery leading away from the heart (the aorta) that occurs below the kidneys (in the abdomen). If such a bulge bursts, hemorrhaging can occur within the abdominal cavity. These aneurysms can be monitored or corrected surgically while the bulge is intact, but require emergency surgery when ruptured.

In the new study, researchers examined patient outcomes of 8,663 operations to repair intact aneurysms and 4,171 to repair ruptured ones from 1987 to 2005. The researchers used the patients' relative five-year survival rate as a key measure. That rate excluded patients who died within 90 days of surgery and was based on a comparison of expected survival rates in a broader population with the same demographic characteristics.

Among patients whose intact aneurysms were repaired during the 18 years of the study, the relative five-year survival rate was 90.3 percent, with patients surviving an average of almost nine years after surgery.

The study found that short-term crude, or actual, survival rates improved among patients who underwent surgery to repair a ruptured abdominal aortic aneurysm. The relative survival rate held steady at about 87 percent. On average, patients who underwent repair for a ruptured aneurysm lived 5.4 years after surgery. Researchers found no significant differences in relative five-year survival rates between men and women or between age groups.

However, researchers found differences in the repair of intact aneurysms. Relative survival was 10.2 percent higher among patients in their 80s than among those age 79 and younger and 4.6 percent higher for male patients than for female patients. Researchers said the survival gap between the sexes in intact repairs may be due to higher levels of atherosclerosis (plaque buildup causing thickening of the arteries) in female versus male patients.

Patients undergoing elective repair of intact aneurysms face low risk and can look forward to close-to-normal longevity after surgery, said Kevin Mani, M.D., lead author of the study and physician at the Department of Vascular Surgery at Uppsala University Hospital in Sweden. "The fact that operative treatment for abdominal aortic aneurysm is offered to older patients, with more frequent cardiovascular disease, could have resulted in inferior long-term outcomes. But this was fortunately not the case. Accurately selected elderly patients can have excellent long-term survival after surgery."

Advances in postoperative care have helped improve both short- and long-term outcomes for patients with intact aneurysms who undergo repair, Mani said. Furthermore, a less-invasive surgical technique known as endovascular aneurysm repair (EVAR) has allowed surgical repair for greater numbers of older patients with additional health problems.

Though patients who underwent EVAR on average were older, "the results of the current study show that patients offered EVAR have the same long-term outcome — relative survival compared to the general population — as patients operated on with more invasive open surgery," Mani said.

Researchers used data from the Swedish Vascular Registry, which Mani describes as a meticulously maintained and validated database that's cross-linked to mortality data from a nationwide population registry. Patient outcomes were followed for an average of nine years.

The study's findings may not necessarily translate to other countries, however. Differences in healthcare systems and clinical decision making for patients pursuing elective abdominal aortic aneurysm repair elsewhere could yield different survival rates, Mani said, noting that elective repair and EVAR are more common in the United States than in Europe.

Nevertheless, general trends toward increased use of EVAR, treatment of older patients with more health problems and improved preventive care in people with existing heart disease are boosting long-term survival globally, he said.

Source: American Heart Association (news : web)

Citation: Long-term survival from abdominal aortic aneurysm repair improving (2009, July 6) retrieved 29 October 2022 from https://medicalxpress.com/news/2009-07-long-term-survival-abdominal-aortic-aneurysm.html

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