Aortic aneurysms are generally without symptoms, and so are normally only discovered by visualisation during a routine check-up or during a clinical examination for another potential condition. Ultrasound scanning, CT and magnetic resonance imaging are all suitable methods for identifying aortic aneurysms. Routine screening of all men aged between 65 and 74 has been instigated in the UK and shown to be cost-effective. Medicare now provides full reimbursement for a screening appointment for men in the same age range who are classified as at risk (family history or cigarette use). Given the published patient benefit and cost-effectiveness of the UK screening programme, its adoption may be seen in other countries in the near future.
A patient is considered a candidate for treatment when the aneurysm has a diameter above 5.5 cm. Below this diameter the risk of rupture is considered lower than the risk of treatment and so the patient will be monitored with periodic ultrasound imaging. Traditional treatment involves abdominal surgery (Figure below - left), where the abdomen is opened with surgery, the aneurysm is excised and an artificial graft is sutured into place.
Where patients are eligible, they may instead receive an endovascular stent graft through an endovascular procedure (Figure below - right), also known as EVAR (EndoVascular Aortic Repair). This procedure constructs a new vessel through which the blood can flow without needing to remove the aneurysm itself. This is therefore a much less traumatic procedure than traditional open surgery.
Identification & Treatment
Effectiveness of screening for aortic aneurysms in England
Open Surgery EVAR