Aortic Aneurysm

An abdominal aortic aneurysm (AAA) is a localized enlargement or weakening of the abdominal portion of the aorta—the main artery that supplies blood to the lower body. Over time, the aneurysm can expand and, if it reaches a certain size, poses a risk of rupture, which can be life-threatening. Because AAAs often develop without symptoms, early detection and routine monitoring are essential to reducing the risk of serious complications.

Diagnosis and Monitoring

Many AAAs are discovered incidentally during imaging performed for other conditions. Once diagnosed, the aneurysm is monitored using established surveillance intervals based on its size and growth rate.

Ultrasound scanning is the primary tool for screening and surveillance of AAAs. It is a safe, accurate, and non-invasive method used to measure the diameter of the aorta and assess for changes over time. Ultrasound is also the preferred method for population-based screening programs, particularly for men over the age of 65, and is routinely used in long-term follow-up of patients with smaller aneurysms.

Endovascular Aneurysm Repair (EVAR)

For patients whose anatomy is suitable, endovascular aneurysm repair (EVAR) offers a minimally invasive approach to treating abdominal aortic aneurysms. This technique involves inserting a stent graft through small incisions in the groin, guided into position within the aorta using imaging. The stent graft reinforces the weakened section of the vessel and prevents further pressure on the aneurysm wall.

Benefits of EVAR may include:

· Smaller incisions and less operative trauma

· Shorter hospital stays

· Faster initial recovery in appropriate candidates

EVAR is performed based on anatomical criteria, patient risk factors, and guideline-directed indications for repair.

Open Surgical Repair

Open surgical repair remains an important and durable treatment option for patients with AAAs that are not amenable to endovascular repair. This involves making an abdominal incision to directly access the aorta and replace the aneurysmal segment with a synthetic graft.

Open repair is typically recommended when:

· The aneurysm has complex anatomy not suitable for EVAR

· There are contraindications to endovascular devices

· Long-term durability is a primary consideration

While recovery is longer than with EVAR, open repair offers excellent long-term outcomes when performed in appropriately selected patients.

Limb Ischaemia

Limb ischaemia occurs when blood supply to the limbs is reduced or completely blocked, depriving the tissues of oxygen and nutrients. This condition can present gradually over time as chronic limb-threatening ischaemia (CLTI), or suddenly, as acute limb ischaemia (ALI), which is a medical emergency.

Causes of Limb Ischaemia

The most common cause is atherosclerosis, a build-up of fatty deposits in the arteries. Other causes include:

· Thrombosis (clot formation within an artery)

· Embolism (a clot or debris travelling from another part of the body)

· Trauma or arterial injury

· Vasculitis (inflammation of blood vessels)

· Arterial dissection or aneurysm

Risk factors include smoking, diabetes, hypertension, high cholesterol, and a family history of vascular disease.

Conservative & Medical Management

For many patients, especially in the early stages or with stable symptoms, conservative management and optimal medical therapy can be highly effective:

Medical Therapy

· Antiplatelet agents (e.g., aspirin or clopidogrel)

· Statins to reduce cholesterol and stabilise plaque

· Antihypertensives for blood pressure control

· Glycaemic control in diabetic patients

· Supervised exercise therapy to improve walking distance and circulation

Lifestyle Changes

· Smoking cessation (crucial to halt disease progression)

· Weight loss and dietary modifications

· Regular physical activity (supervised walking programmes are highly beneficial)

This approach aims to reduce cardiovascular risk, improve symptoms, and slow disease progression.

Surgical & Endovascular Interventions

When symptoms progress or threaten the viability of the limb, surgical or minimally invasive intervention may be necessary.

Endovascular Techniques

· Angioplasty – inflating a small balloon inside the artery to open the blockage

· Stenting – placing a metal scaffold to keep the artery open

· Atherectomy – removal of plaque from the artery wall

Surgical Techniques

· Bypass surgery – creating a new route for blood flow using a vein or synthetic graft

· Thromboembolectomy – removing a clot in acute limb ischaemia

· Endarterectomy – removing plaque from inside the artery

· Amputation – considered only when tissue is non-viable and all revascularisation options have been exhausted

The choice of procedure is tailored to each patient, based on their anatomy, comorbidities, and overall goals of care.

A Patient centred approach

Every patient deserves a personalised care plan, whether that involves conservative therapy, endovascular treatment, or open surgery. My goal is to preserve limb function, reduce pain, and improve quality of life, using the latest evidence-based techniques and multidisciplinary care.

All treatment decisions are guided by current clinical guidelines and tailored to the individual patient’s health and personal preferences. Whether through EVAR or open repair for Aneurysms or endovascular and open repair for legs, my focus is on providing safe and effective treatment tailored to a patients needs

If you are worried about Aortic Aneurysms or have been found to have one through other means and would like to discuss.

If you’re experiencing leg pain when walking, non-healing ulcers, or have concerns about your circulation, early assessment is key.

Please don’t hesitate to get in touch for a comprehensive vascular consultation