If testing reveals an abdominal aortic aneurysm (AAA), the decision to monitor or treat the AAA must be made. In general, three factors help determine treatment:

• The presence of symptoms. Physicians are more likely to recommend surgical repair of an aneurysm that has symptoms, even if it is relatively smaller.

If surgery is not required, physicians will usually recommend yearly ultrasounds to carefully watch the aneurysm. They may also prescribe quitting smoking and certain medications to help keep the aneurysm stable. In addition, patients may be advised to control as many risk factors for heart disease as possible, including cholesterol levels and blood pressure. This may require medications and lifestyle changes. Although the link between treating risk factors for heart disease and the risk of aneurysm rupture or growth remains mysterious, a number of studies have shown that patients with AAA live longer on average by addressing these issues. This is also true for patients who have already undergone treatment for AAA, including surgery.

If surgery is required, one of two general methods will be performed to repair AAAs: surgery and endovascular repair. During surgery, the physician will open the torso to expose the aorta, clamp it above and below the AAA, and sew in a synthetic graft.

An endovascular procedure is a minimally invasive, catheter-based treatment using a stent. It is usually recommended for patients who are poor candidates for open surgery. The stent is usually delivered on a catheter that is introduced to the body through the femoral artery (near the thigh) and guided up into the aorta. In this way, blood flow is diverted away from the aneurysm. Only half of aneurysms can be treated with stent grafts as the procedure can only be performed if the aneurysm has certain features. The success rate of this procedure has been estimated at 90 percent in some studies.

However, the procedure is not without the risk of complications, such as endoleak (an incomplete seal around the stent causing blood to leak back into the aneurysm). Researchers are also testing so-called “fast track” endovascular repair, with more specialized instruments, smaller incisions and shorter operating time.

Patients are encouraged to have a detailed discussion with their physicians regarding the differences, advantages and disadvantages of open or endovascular repair. Vascular surgeons, interventional cardiologists or radiologists who have been specifically trained in each treatment area may conduct these procedures.