Endovascular Surgery using Stent Grafts

Endovascular Surgery using Stent Grafts is being performed for thoracic and abdominal aortic aneurysms. This is a combination approach, which allows for a minimally invasive alternative to open surgical reconstruction. 

Abdominal Aortic Aneurysm (AAA)

General Information

  • Aortic aneurysm is a leading cause of death in the US (#9 for men and #13 for all Americans)
  • Defined as a focal dilation of >50% of normal expected diameter (>3 cm for most people)
  • Risk factors include: smoking, male gender, age > 60, hypertension and family history
  • Often there are no symptoms, but may present with abdominal pain or pulsating mass
  • Approximately 5% of men > age 65 have abdominal aortic aneurysms

Diagnostic Tests To Consider

  • Ultrasound - best noninvasive test for screening and serial measurement of aneurysms
  • CT scan with IV contrast (request protocol for AAA evaluation) or MRI/MRA may be indicated if ultrasound is technically limited, or if the aneurysm extends above the renal arteries
  • Indications for Abdominal Aorta Ultrasound:
    • Diagnostic Evaluation for an Abdominal Aortic Aneurysm
      • Palpable/pulsatile abdominal mass
      • Unexplained lower back pain, flank pain, or abdominal pain
      • Follow-up of a previously demonstrated abdominal aortic aneurysm
      • Follow-up of patients with an abdominal aortic and/or iliac stent graft
    • Screening Evaluation for an Abdominal Aortic Aneurysm
      • Patients > age 50 with a first-degree relative with AAA
      • Males age 65-75 who are current or previous smokers

Management of Patients With AAA

  • Smoking cessation and blood pressure control (< 130/85) may reduce risk of AAA growth
  • Size of AAA: (Aneurysm diameter is the most important factor associated with rupture risk)
    • Diameter 3.0-4.5 cm: Abdominal ultrasound every 6 months to 1 year
    • Diameter > 4.5 cm: Refer to vascular specialist for further management