The Vascular Surgery team at the University of Michigan is a group of world class surgeons, nurses, allied health professionals, and clinical researchers dedicated to providing exceptional treatment for Abdominal Aortic Aneurysms (AAA) in the U-M Cardiovascular Center (CVC), our new state-of-the-art clinical building.

Our surgeons have pioneered new endovascular surgical techniques, and continue to discover and perfect the newest and most effective treatments for AAA. In addition, U-M physicians and researchers are seeking better understanding of the root causes of the condition and are currently examining certain antibiotics to slow aneurysm growth.

What is an Aortic Aneurysm?

An Aortic Aneurysm is a term describing the ballooning or enlargement of the aorta. The condition can occur in any portion of the aorta, but most commonly occurs in the abdomen, otherwise referred to as abdominal aortic aneurysm or AAA. The primary concern of this condition is the increased risk for rupture of the aorta, which causes massive bleeding, and will quickly result in death. AAA's are the tenth leading cause of death in men over 50 in the US, with ruptures accounting for approximately 20,000 deaths each year.

Conditions	Treatments
Abdominal Aortic Aneurysm (also known as: AAA, thoracoabdominal aortic aneurysm)	Open surgical repair with grafting Endovascular Aortic Repair (EVAR) Serial Observation

What are the symptoms of Abdominal Aortic Aneurysms?

An abdominal aortic aneurysm typically produces no symptoms, but as the size of the aneurysm increases, abdominal and/or back pain may develop. Other symptoms may include pain radiating to the groin and a pulsating mass in the abdomen.

What causes Abdominal Aortic Aneurysms?

Although the exact cause of aortic aneurysms is unclear, risk factors such as smoking, in conjunction with diseases such as hypertension all increase the probability of developing the condition.

How are Abdominal Aortic Aneurysm's diagnosed?

Diagnosis of an abdominal aortic aneurysm is typically made via a screening ultrasound examination, although CT scans of the abdomen obtained for other reasons are another common avenue whereby aneurysms are detected.

Medicare now provides coverage for qualified seniors to check for Abdominal Aortic Aneurysm. Men who have smoked at least 100 cigarettes during their life, and men and women with a family history of AAA qualify for the one-time ultrasound screening.

Enrollees must visit their healthcare professional for their Welcome to Medicare physical within six months of enrolment in order to qualify for the free screening. The Welcome to Medicare Physical Exam must be completed within the first six months of Medicare eligibility, but there is no published time limit thereafter for completion of the AAA screening. Providers who perform the physical examination and order the AAA screening need to document the AAA risk factors.

How is Abdominal Aortic Aneurysm Treated?

There are two surgical options for the treatment of AAA, open surgical repair, and minimally invasive endovascular aneurysm repair (EVAR). Typically, surgical repair of either type is only recommended when the diameter of the aneurysm exceeds 5 cm, with the risk of aortic rupture at that size being greater that the risk associated with the surgery. Aneurysms below 5 cm are medically managed and monitored (serial observation).

Open Surgical Repair of AAA

Open surgical repair of the AAA involves an abdominal incision to gain access to aneurysm. The aneurysm is opened and a graft, typically made of Dacron™ or Gore-tex™, is sutured into the proximal and distal ends of the aorta and fixed into place. The dilated portion of the aorta is then closed over the graft.

Endovascular Aneurysm Repair (EVAR)

Endovascular Aneurysm Repair (EVAR) has recently emerged as a minimally invasive alternative to open surgical repair, but is only suitable under certain conditions. The procedure involves small incisions in the groin to allow for insertion and positioning of an endovascular stent graft at the location of the aneurysm.

Benefits of EVAR include significantly shorter hospital stays, and lower risk for peri-operative death (death within a month of surgery). Long-term studies are still underway, but current research indicates that the procedure does not offer any long-term survival or quality of life benefits over open surgical repair.

What can I do to prevent Abdominal Aortic Aneurysms?

Although the exact cause on AAA is unclear, you can reduce your risk for developing the condition by following these guidelines:

Don't smoke
Lower your blood pressure if it is high
Eat foods low in fat and cholesterol
Lose weight if you are overweight
Exercise regularly according to your health care provider's recommendations

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