Abdominal Aortic Aneurysm Repair in India

An abdominal aortic aneurysm (AAA) is a localized enlargement of the abdominal aorta, the major blood vessel that supplies blood to the lower part of the body. There is a high risk of rupture, which can result in life-threatening internal bleeding. There is a significant risk of rupture, which can result in severe and potentially fatal internal blood loss. Early detection and timely repair are essential to prevent catastrophic outcomes. Thus, this guide looks into the different aspects of AAA repair, including types, symptoms, diagnosis, risks, complications, causes, preparation, procedure, recovery, clinical trials, side effects, success rates, post-treatment diet, cost in India, and conclusion, among others, along with frequently asked questions.

Types of Abdominal Aortic Aneurysm Repair

1. Open Surgical Repair (OSR): This procedure involves making a large incision into the abdomen to directly visualize the aneurysm. The affected part of the aorta is then replaced with an artificial graft.

2. Endovascular Aneurysm Repair (EVAR): This is a minimally invasive surgery in which a stent-graft is guided to the location of the aneurysm and put in place through small cuts in the groin. This strengthens the wall of the aorta.

3. Hybrid Repair: In complex cases, hybrid repairs combine elements of open and endovascular surgery.

Symptoms

Many AAAs are asymptomatic and are an incidental finding on imaging studies done for other reasons. However, when symptoms do arise, they could be:

• Feeling of a Pulsating Sensation: When checking near the navel, a pulse can be noted.

• Deep and Persistent Pain: Could originate in the abdomen or on a side of it.

• Pain in the Back: Could be persistent and of significant intensity radiating from the abdomen.

• Joint Pain and Postural Blood Pressure Fall: Rupture of the aneurysm may mean abrupt, unbearable, severe pain experienced by the patient. The rupture gives symptoms of dizziness and near syncope.

Diagnosis

1. Physical Exam: The patient's abdomen may have a pulsatile mass.

2. Ultrasound: The most commonly used screening test for AAA.

3. CT scanning: It enables comprehensive characterization of the size and extent of the aneurysm.

4. MRI: Used in some cases for further detailed imaging without radiation.

5. Angiography: Gives us an invasive view of flow status and aneurysm structure.

Risks and Complications of Abdominal Aortic Aneurysm

• Rupture: Most severe complication, resulting in a life-threatening condition because of internal bleeding.

• Thrombosis: It may accompany an aneurysm and spread throughout the body.

• Compression of Surrounding Organs: More impairment or fewer symptoms.

• Infections: Rare but may arise untreated or after surgery.

• Dissection of the Aorta: An unsuspecting tear that fosters later rupture.

Causes

• Atherosclerosis can lead to the hardening of the arteries following the buildup of plaques.

• There can be a genetic predisposition to aneurysms.

• High blood pressure contributes significantly due to increased pressure on the aortic wall.

• Smoking causes a major risk factor associated with a weakness of the aortic wall.

• The risk of developing an aneurysm is higher in men over 65 years of age.

• A lesser number of aorta-weakening causes are infection and trauma.

Preparation

1. Medical evaluation, which includes imaging, blood work, and cardiovascular function testing.

2. Management of Drugs Involved: Goes to modifying or, in some cases, stopping drugs that act as blood thinners.

3. Lifestyle Changes: Quitting smoking is a must, managing blood pressure, and optimizing health with wellness.

4. Preoperative Preparation: A small, low-fiber, liquid diet should be followed the day before any significant operation, and an enema at home may be beneficial. The patient or caregiver must ensure that all necessary views and reports are collected, the consent forms are signed, the aeration sheet is prepared, the closing of one-day admissibility, bed availability, etc.

Procedure

1. Open Surgery Repair (OSR):

General anesthesia is given.

          o   A long incision is made in the abdomen to gain access to the aorta.

          o   The aneurysmal part is excised and replaced by a synthetic graft.

          We stitch the wound and transfer the patient to the ICU (Intensive Care Unit).

2. Endovascular Aneurysm Repair (EVAR):

          o   The patients are given regional or general anesthesia.

          o   A wire is introduced through the femoral artery by making a small cut at the groin region.

          o   The aneurysm is negotiated with a catheter; when an ideal position is reached, then a stent graft is released to the aortic wall for reinforcement.

          o   The small cuts are sutured, and recovery is faster than OSR.

Recovery

• Recovery Period: Patients undergoing OSR typically stay in the hospital for 5–10 days, while those undergoing EVAR may leave as soon as 2-3 days after surgery.

• Pain Management: Prescription of analgesics post-surgery for a comfortable recovery.

• Activity Restrictions: No heavy lifting or strenuous exercises for about three or four weeks.

• Follow-Up Appointments: Regular monitoring via scanning to keep tabs on repair, especially post-EVAR.

• Modification of Lifestyle: Continue with the management of controlling blood pressure and blood lipid profile, and avoid smoking.

Clinical Trials

Research findings continuously improve the method and materials used for AAA, or aneurysm repair. The clinical trials on which research is being concentrated include less invasive techniques, more favorable stent designs, and whether or not the repairs will last in the long term.

Side effects

• Infection: May occur in nearly every place, either at the incision site or within the stent graft.

• Hemorrhage: bleeding that happens during or after surgery.

• Prosthesis malfunctions: These include persistent issues such as leakage, shifting, or occlusion.

• Clots: Risk of embolization following surgery

• Renal Infarction: A condition caused by contrast dye during imaging.

• Damage to Nerves: Such as numbness or weakness in the lower extremities

Success Rate

• Open Surgical Repair: The success rate reaches higher levels, with 90-95% of patients living healthily if the operation is carried out before rupture.

• Endovascular Aneurysm Repair (EVAR): The same rate with a speedier recovery and fewer immediate complications despite the need for vigilant long-term follow-up.

Diet to follow treatment

• Low-Sodium Diet: Very useful in controlling blood pressure.

• Fiber-rich Diet: To avoid constipation right after surgery.

• A Healthful Heart Diet: Includes fruits, vegetables, whole grains, lean meat, and beneficial fats.

• Adequate Water: To maintain recovery, you must reclaim enough fluids.

• Stop using alcohol and caffeine to sustain consistent blood pressure.

Cost of Abdominal Aortic Aneurysm Repair in India

• Open Surgical Repair: 3 lakhs to 6 lakhs, depending on the hospital and city.

• Endovascular Aneurysm Repair (EVAR): 5 lakhs to 10 lakhs, stent-grafts, and other sophisticated device costs included

• Post-Operative Care: Expenses incurred for immediate follow-up imaging, medications, and doctor follow-ups

Conclusion

When used in the patient's best interest at the appropriate time, abdominal aortic aneurysm repair procedures can preserve life. Modern medical technologies have made it possible for patients to undergo open repair and endovascular repair techniques, offering them high success rates and quick recovery times. Regrettably, owing to certain late possibilities, the most acceptable regimen for improving the patient's life would be early detection based on routine diagnostic measures for high-risk population items. These methods help patients even more by coming up with changes they can make to their lifestyle, prescribing medicine to treat conditions that can make AAA worse, and making sure they get regular checks.