HEALTH CONDITION

Treatment

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.

Small and medium AAAs

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 your aneurysm becomes a large AAA.

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.

Large AAAs

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, and you may 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'll 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. Around 98% of people make a full recovery.

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

Open surgery

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. Around 95 to 97% of people make a full recovery.

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 normally need regular scans to check it.

Treatment for a burst AAA

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.

Only about 2 in 10 people who have a burst aneurysm survive, which is why an operation to stop an aneurysm bursting is usually recommended if it's large.


Page last reviewed: Sat Jul 2020 Next review due: Tue Feb 2020

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