Abdominal Aortic Aneurysm Repair

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Abdominal Aortic Aneurysm Repair

(AAA Repair)

Definition

The aorta is the largest artery in the body. The abdominal portion of the aorta carries blood to the abdomen, pelvis, and legs. Sometimes the walls of the aorta weaken and bulge in one area. This is called an abdominal aortic aneurysm (AAA). AAAs are most often caused by atherosclerosis, also known as hardening of arteries, and high blood pressure.

Abdominal Aortic Aneurysm

Reasons for Procedure

Surgery to repair an AAA is often done when the aneurysm:

Causes physical symptoms such as abdominal pain
Reaches a size of five centimeters (2 inches) across or has been growing rapidly. Smaller aneurysms are watched closely. They are rarely repaired with surgery.
Has burst—Surgery must be done right away.

Preventive AAA surgery generally has a good outcome for people who are relatively healthy. Emergency surgery to fix an AAA rupture has a much lower survival rate, due to the rapid loss of blood.

Possible Complications

Your doctor will review a list of possible complications, which may include:

Problems from general anesthesia, including lightheadedness, low blood pressure, and wheezing
Infection
Bleeding
Damage to organs
Death

Some factors that may increase the risk of complications include:

Smoking
Heart disease
Previous episodes of transient ischemic attack (TIA) or stroke
Lung disease
Weakness due to cancer
Diabetes
Obesity

What to Expect

The procedure varies. It can be done before a rupture as a preventive measure or after a rupture on an emergency basis. The preventive procedure is outlined here.

Prior to Procedure

Your doctor may need detailed pictures of your abdomen, heart, and lungs. These can be made with:

Your doctor may also need a record of your heart activity. This can be made with an electrocardiogram.

Your doctor may ask you to see a cardiologist—a doctor who specializes in heart conditions. The cardiologist will check your heart before surgery.

Before the procedure:

You may need to stop taking certain medicines one week before surgery. Talk to your doctor about your regular medicine, especially:
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Blood-thinning drugs
- Anti-platelet drugs

On the day of the procedure, you will be given an antibiotic by IV. You may also be given a laxative or enema to clear out your bowels.

Anesthesia

General anesthesia will be used. It will block any pain and keep you asleep through the surgery. It is given through an IV.

Description of Procedure

In most cases, an incision is made from the breastbone to below the belly button. The doctor clamps the aorta slightly above and below the aneurysm. Any blood clot on the inside of the aorta is removed. An artificial wall is used to strengthen the area. This is called a graft. The graft will be stitched to the normal aorta on either side. Then, the clamps are removed. The wound is closed with stitches.

Abdominal Aortic Aneurysm Surgery

An artificial graft is stitched to the aorta.

How Long Will It Take?

About 4-6 hours

How Much Will It Hurt?

Anesthesia prevents pain during the procedure. Most people will be sore after the procedure and will be given pain medicines.

Average Hospital Stay

The length of your hospital stay depends on your overall condition. Ask your doctor how long you should plan to stay.

Post-procedure Care

At the Hospital

While you are recovering at the hospital, you may receive the following care:

You will be sent to the intensive care unit for monitoring.
You will have tubes in place, which may include the following:
- IV—provides medications and fluids
- Urinary catheter—monitors urine output
- Arterial catheter—monitors blood pressure
- Central venous catheter—monitors pressure in the heart
- Epidural catheter—provides pain medicine
- Nasogastric tube—inserted through the nose and into the stomach to remove secretions and provide nutrition until your intestines regain normal function

At Home

When you return home, do the following to help ensure a smooth recovery:

Follow any discharge instructions to care for the wound.
Gradually return to your normal activities.
To help prevent further problems, you and your doctor will need to work to increase your overall health. Atherosclerosis and high blood pressure should be managed carefully. This can be done with medicines and a healthy lifestyle. If you are a smoker, you should talk to your doctor about quitting.

Also, ask your doctor about when it is safe to shower, bathe, or soak in water.

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occurs:

Redness, swelling, increasing pain, excessive bleeding, or discharge at the incision site
Signs of infection, including fever and chills
New abdominal pain
Back pain
Any change of color or sensation in your legs or feet
Burning, pain, or problems when urinating
Nausea or vomiting
Abdominal cramps or diarrhea
Unusual fatigue or depression
Disorientation or confusion
Numbness or tingling in the legs
New, unexplained symptoms
Cough, shortness of breath, or chest pain

In case of an emergency, call for medical help right away.

RESOURCES

National Heart, Lung, and Blood Institute, NIH http://www.nhlbi.nih.gov

The Society for Vascular Surgery http://www.vascularweb.org

CANADIAN RESOURCES

The Canadian Society for Vascular Surgery http://canadianvascular.ca

Heart and Stroke Foundation of Canada http://ww2.heartandstroke.ca

References

Abdominal aortic aneurysm (AAA). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 18, 2013. Accessed May 6, 2013.

Abdominal Aortic Aneurysm (AAA). American Academy of Family Physicians' FamilyDoctor.org website. Available at: http://familydoctor.org/online/famdocen/home/articles/883.html. Updated July 2010. Accessed May 6, 2013.

Hall SW. Endovascular repair of abdominal aortic aneurysms (Home Study Program). AORN Journal. 2003;77(3):630-642.

6/2/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.

Revision Information

Reviewer: Michael J. Fucci, DO Michael Woods, MD
Review Date: 05/2013 -
Update Date: 05/06/2013 -

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

Cartersville Medical Center