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Abdominal Aortic Aneurysm (AAA)

Abdominal Aortic Aneurysm (AAA)

An ultrasound scan of your aorta is sometimes called a “duplex scan.” The aorta is the main artery that carries blood from the heart to the rest of the body. An abdominal aortic aneurysm (AAA) is a dilation of the main blood vessel in the abdomen due to a weakening of the vessel wall. This condition is seen in men and women, but the risk increases with age and certain risk factors (smoking, high blood pressure, family history). It is most common in men aged 65 or over, and as such this group is automatically invited to attend a screening test as part of a national screening programme.

AAAs can be detected using duplex ultrasound by viewing the aorta and measuring the distance between the walls of the vessel to determine whether it is within a normal range of sizes. The test is painless and does not use any radiation or needles.

It may not be possible to see the artery along its full length if it is obscured by bowel gas. This occurs in some patients regardless of their diet, and is a common problem when scanning the abdomen because we are scanning through the bowels. If this occurs, the Vascular Scientist performing your scan might attempt to scan your abdomen from different positions, and/or ask you to move into a different position (for example, onto your side).

What will Happen?

You may eat and drink as usual prior to the test and you do not need to remove your hearing aid or glasses.
You will be asked to lay on the bed on your back. The vascular scientist will ask you to pull up you shirt/blouse and possibly lower your trousers slightly so we can get to your tummy.
A water-based gel, which may feel cold, and a probe will be placed onto your tummy.
Images will appear on the screen of your blood vessels, similar to the picture above. You may hear some noises from the machine but this is perfectly routine.
A clinical vascular scientist (who might be male or female) will perform and interpret your ultrasound scan.

Image 1. Large Abdominal Aortic Aneurysm

Endovascular aneurysm repair (EVAR)

Abdominal aortic aneurysms (AAA) occur when the wall of the aorta (the largest artery in your body) becomes weakened, resulting in it expanding to form an aneurysm. This can enlarge and develop into a potentially serious health problem. This can be fatal if the aneurysm becomes so enlarged it bursts. The normal diameter of the aorta is approximately 1-2cm. It is considered aneurysmal when it expands to over 3cm. When the diameter reaches 5.5 cm patients may be offered an operation. Traditionally invasive major surgery where a big incision is made along the abdomen, called open-surgery, has been used to repair an AAA. However, there is a less invasive option called Endovascular Aneurysm Repair (EVAR).

EVAR is a new innovative form of keyhole surgery that is less invasive than open surgery and uses a stent to reinforce the wall of the aorta. Not all patients are suitable for this type of surgery. Although, less invasive, patients who have EVAR can develop complications where the main complication is when a leak develops from the stent into the aneurysm and is call an ‘endoleak’. Endoleaks can occur from a gap in the adjoining sections of the stent, movement ‘migration’ of the stent from the desired location, or a leak into the aneurysm from a surrounding artery that has not been isolated during the procedure. Due to the risk of endoleaks patients are continually followed up after EVAR using ultrasound. This is sometimes known as a ‘Duplex’. This scan is a simple, non-invasive procedure that takes around 30 minutes. If a leak is detected your surgeon will then decide whether an intervention needs to be taken.

What will Happen?

You may eat and drink as usual prior to the test and you do not need to remove your hearing aid or glasses.
You will be asked to lay on the bed on your back. The vascular scientist will ask you to pull up you shirt/blouse and possibly lower your trousers slightly so we can get to your tummy.
A water-based gel, which may feel cold, and a probe will be placed onto your tummy.
Images will appear on the screen of your blood vessels, similar to the picture above. You may hear some noises from the machine but this is perfectly routine.
A clinical vascular scientist (who might be male or female) will perform and interpret your ultrasound scan.