Dr. Yugal Mishra

Abdominal Aortic repair and replacement

Abdominal Aortic repair and replacement procedures are surgical interventions used to treat diseases or conditions affecting the abdominal segment of the aorta, which is the portion of the aorta located in the abdomen. These procedures are performed to address abdominal aortic aneurysms or other pathologies in the abdominal aorta.

  1. Abdominal Aortic Aneurysm Repair: Abdominal aortic aneurysm (AAA) repair involves surgical intervention to treat a localized dilation or bulging of the abdominal aorta. The procedure may involve two main approaches:
  2. Open Repair: In open AAA repair, a large incision is made in the abdomen to access the aneurysm. The weakened or diseased segment of the aorta is replaced with a synthetic graft to reinforce the aortic wall and prevent the risk of rupture.
  3. Endovascular Aneurysm Repair (EVAR): EVAR is a minimally invasive procedure where a stent graft is delivered through small incisions in the groin area. The stent graft is guided to the site of the aneurysm and deployed, reinforcing the weakened aortic wall and diverting blood flow away from the aneurysm.
  4. Other Abdominal Aortic Pathologies: Abdominal aortic repair and replacement procedures can also be used to address other conditions affecting the abdominal aorta, such as aortic dissections, aortic ulcers, or other forms of aortic pathology. The specific surgical approach depends on the nature and extent of the condition.



Abdominal aortic repair and replacement procedures are indicated for individuals with specific conditions affecting the abdominal segment of the aorta. The following are common indications for these procedures:

  1. Abdominal Aortic Aneurysm (AAA): Surgical intervention for AAA may be indicated under the following circumstances:
  2. Size Criteria: If the diameter of the AAA reaches a certain size threshold (usually around 5.5 centimeters or larger), surgical repair or replacement is often recommended to prevent the risk of rupture, which can be life-threatening.
  3. Rapid Growth: If an AAA shows rapid expansion, regardless of its size, surgical intervention may be indicated to mitigate the risk of rupture
  4. Symptoms or Complications: If the AAA causes symptoms such as abdominal or back pain, or if it leads to complications such as blood clot formation (thrombus) within the aneurysm or evidence of leakage, surgery may be warranted.
  5. Aortic Dissection: Abdominal aortic repair and replacement may be indicated for individuals with aortic dissection that extends into the abdominal aorta. Surgery is typically performed to repair or replace the affected segment of the aorta, stabilize the dissected layers, and restore normal blood flow.
  6. Traumatic Aortic Injury: In cases of traumatic injury to the abdominal aorta, repair or replacement procedures may be necessary to address the damaged segment and restore vascular integrity.



There are certain contraindications or factors that may make abdominal aortic repair and replacement procedures less suitable or pose increased risks for certain individuals. These contraindications may include:

  1. Poor Overall Health: Individuals with significant comorbidities, such as severe heart or lung disease, advanced kidney or liver dysfunction, or other serious medical conditions, may not be good candidates for abdominal aortic repair or replacement due to increased surgical risks.
  2. High Surgical Risk: Some patients may have a high surgical risk profile, such as advanced age, frailty, or a history of previous unsuccessful surgeries, making them less suitable for invasive procedures.
  3. Unstable Hemodynamics: Patients who are hemodynamically unstable, meaning their blood pressure or heart function is severely compromised and not responsive to medical management, may not be good candidates for immediate surgical intervention.
  4. Limited Life Expectancy: Individuals with limited life expectancy due to advanced age or terminal illness may not benefit significantly from abdominal aortic repair or replacement, as the potential benefits may not outweigh the risks and recovery period.
  5. Unfavorable Anatomy: Certain anatomical features or complexities, such as extensive scarring, severe tortuosity (twisting), or calcification of the aorta, may make the surgical procedure technically challenging or risky.
  6. Patient Preferences: Individual patient preferences and goals of care are also important factors to consider. Some patients may choose to pursue non-surgical management or palliative care instead of undergoing invasive procedures.