Aortic Aneurysm RepairBy
Sarah Lewis, PharmD
What is an aortic aneurysm repair?
Aortic aneurysm repair is surgery to fix an aortic aneurysm. An aortic aneurysm is a weakened area in the aorta. Your aorta is the main blood vessel (artery) leaving your heart and passing down through your chest and abdomen (belly). With time, a weakened area can grow, stretch, and balloon outward. Left untreated, an aortic aneurysm can burst and bleed heavily. Aortic aneurysm repair prevents or treats this life-threatening condition.
Aortic aneurysm repair involves removing or reinforcing the diseased part of your aorta with synthetic material, called a graft.
Aortic aneurysm repair is a major surgery with serious risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all of your treatment choices before having an aortic aneurysm repair.
Types of aortic aneurysm repair
The types of aortic aneurysm repair procedures include:
Abdominal aortic aneurysm repair (AAA repair) repairs an aortic aneurysm that occurs in the part of your aorta that is in your abdomen (belly). This is the most common type of aortic aneurysm.
Thoracic aortic aneurysm repair repairs an aortic aneurysm that occurs in the part of your aorta that is in your chest.
Other procedures that may be performed
Your doctor may perform other procedures in addition to aortic aneurysm repair. This is most common with thoracic (chest) aortic aneurysm repairs.
Additional procedures may include:
Aortic valve repair or replacement, which you may need if the aneurysm is close to your heart. The aortic valve opens to allow blood to leave your heart and closes to prevent blood from flowing back into your heart.
Heart surgery, which you may need if heart disease has contributed to your aortic aneurysm
Why is aortic aneurysm repair performed?
Your doctor may recommend an aortic aneurysm repair to treat an aortic aneurysm. An aneurysm is a weakened area in a blood vessel wall that widens and bulges. Over time, this weakened area can grow, stretch, and balloon outward. Aneurysms are serious health conditions because they can burst and cause life-threatening internal bleeding.
Aneurysms can occur in any blood vessel in your body, but they most commonly occur in the aorta. Your aorta is the main blood vessel that carries blood from your heart. It passes down through the chest and abdomen (belly). A ruptured or burst aortic aneurysm is a medical emergency. Few people survive a ruptured aortic aneurysm. This is because it causes rapid, massive blood loss.
Atherosclerosis is the most common cause of aortic aneurysms. Atherosclerosis is a buildup of plaque inside arteries. It can lead to blood vessel narrowing and hardening of the arteries. This can weaken the wall of the artery. Other causes of aortic aneurysm include smoking, high blood pressure, trauma, and congenital (present at birth) defects.
Your doctor may watch your aneurysm over a period of time. Your doctor may prescribe medication to slow the growth of the aneurysm or lower your blood pressure. This reduces pressure on the aneurysm.
Many aortic aneurysms eventually need surgical repair. Ask your doctor about all of your treatment options and the timing of your repair. Consider getting a second opinion if your situation is not an emergency before deciding on an aortic aneurysm repair.
Your doctor may recommend aortic aneurysm repair if your aneurysm is:
Causing symptoms. Most aortic aneurysms do not cause symptoms. When they occur, symptoms of an abdominal aortic aneurysm may include abdominal (belly) pain, low back pain, or feeling your heartbeat in your abdomen. Symptoms of a thoracic aortic aneurysm may include chest pain, back pain, neck or jaw pain, coughing, hoarseness, and difficulty breathing. Having symptoms may be a sign that your aortic aneurysm is about to burst. This is a medical emergency.
Growing rapidly, about ¼ inch over the last six to 12 months
Interfering with blood flow to other areas of your body, such as your legs
Larger than two inches, or about five centimeters
Leaking blood into the layers of the walls of your aorta (aortic dissection)
Rupturing. A ruptured or burst aortic aneurysm is a medical emergency. Symptoms of rupture include severe and sudden abdominal or back pain, anxiety, nausea, vomiting, pale and clammy skin, dry mouth, excessive thirst, and signs of shock. Signs of shock include weakness, dizziness, fainting, shaking, sweating, and rapid heartbeat.
Who performs aortic aneurysm repair?
The following specialists commonly perform an aortic aneurysm repair:
Vascular surgeons specialize in the surgical treatment of blood vessel diseases.
Thoracic surgeons specialize in the surgical treatment of diseases of the chest, including the blood vessels, heart, lungs and esophagus. Thoracic surgeons may also be known as cardiothoracic surgeons.
Other specialists who repair aortic aneurysms include:
Cardiac surgeons specialize in the surgical treatment of heart and blood vessel conditions. Cardiac surgeons may also be known as cardiothoracic surgeons.
Interventional cardiologists specialize in diagnosing and treating heart disease using catheter procedures and radiological imaging.
Vascular and interventional radiologists specialize in the treatment of blood vessel and other conditions using catheter-based procedures and imaging techniques.
How is aortic aneurysm repair performed?
Your aortic aneurysm repair will be performed in a hospital using one of the following approaches:
Minimally invasive surgery (endovascular aortic aneurysm repair, or EVAR) involves inserting a catheter and guide wire through an artery in your groin or leg. Your doctor feeds or guides the catheter guide wire to the aortic aneurysm. The catheter tip has a deflated synthetic graft, which expands like a spring once the catheter is in place. The synthetic graft reinforces the walls of your aorta. Your blood now flows through the graft. Endovascular surgery generally involves a faster recovery, less pain, and less risk of complications than open surgery. This is because it causes less trauma to tissues and organs. It may be a good option if you are not a candidate for open surgery. However, it cannot repair all types of aneurysms.
Open surgery involves making a large incision in the chest or abdomen (belly). Your doctor removes the weakened part of your aorta and replaces it with a synthetic graft. Your doctor might also cut open the aneurysm and place the graft inside. Open surgery allows your doctor to directly see and access the surgical area. Open surgery generally involves a longer recovery, a higher risk of complications, and more pain than minimally invasive surgery. Open surgery requires a larger incision and more cutting and displacement of muscle and other tissues and organs than minimally invasive surgery. Despite this, open surgery may be a safer or more effective method for certain patients.
Your doctor will advise you on which procedure is best for you and how long you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different types of aortic aneurysm repair and ask why your doctor will use a particular type of procedure for you.
Types of anesthesia that may be used
Your surgeon will perform your aortic aneurysm repair using either general anesthesia or regional anesthesia.
General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the surgery and will not feel any pain. You may also have a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.
Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb a large area of the body. To numb a smaller area, your doctor injects the anesthetic in the skin and tissues around the procedure area (local anesthesia). You will likely have sedation with regional anesthesia to keep you relaxed and comfortable.
What to expect the day of your aortic aneurysm repair
The day of your surgery, you can generally expect to:
Talk with a preoperative nurse. The nurse performs an exam and ensures that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.
Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth.
Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have.
A surgical team member starts an IV.
The anesthesiologist or nurse anesthetist starts your anesthesia.
A tube is placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.
A catheter will be placed in your bladder when you are asleep. This is to monitor your urine output.
The surgical team monitors your vital signs and other critical body functions. This occurs throughout the surgery and recovery until you are alert, breathing effectively, and your vital signs are stable.
What are the risks and potential complications of aortic aneurysm repair?
As with all surgeries, an aortic aneurysm repair involves risks and possible complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.
General risks of surgery
General risks of surgery include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Bleeding, which can lead to shock and require blood transfusion
Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can travel to your lungs, heart or brain and cause a pulmonary embolism, heart attack, or stroke.
Infection and septicemia, which is the spread of a local infection to the blood
Potential complications of aortic aneurysm repair
Complications of an aortic aneurysm repair include:
- Blockage of the graft
- Blood leaking from the graft
- Blood vessel damage
- Bowel damage if the surgery involves your abdomen
- Nerve damage
- Sexual problems if nerve injury affects nerves in your groin
- Spinal cord injury
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery
Informing your doctor or radiologist if you are nursing or if there is any possibility of pregnancy
Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for my aortic aneurysm repair?
You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome.
You can prepare for an aortic aneurysm repair by:
Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Getting preoperative testing as directed. Testing varies depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
Losing excess weight before the surgery through a healthy diet and exercise plan
Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. You may also be instructed to take a laxative to clean out your bowels the day before surgery.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments.
It is also a good idea to bring a list of questions to your appointments. Questions can include:
Why do I need aortic aneurysm repair? Are there any other options for treating my condition?
Which type of surgery do I need?
How long will the surgery take? When can I go home?
What restrictions will I have after the surgery? When can I return to work and other activities?
What kind of assistance will I need at home?
What medications will I need before and after the surgery? How should I take my usual medications?
How will you treat my pain?
When should follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my aortic aneurysm repair?
Knowing what to expect can help make your road to recovery after an aortic aneurysm repair as smooth as possible.
How long will it take to recover?
You will stay briefly in the recovery room after surgery until your vital signs are stable. Your care team will then move you to an intensive care unit (ICU). ICUs provide 24-hour monitoring and specialized care.
It may take a few hours until the major effects of anesthesia wear off and you are alert. When you wake up, you may have a breathing tube in your mouth and tubes and wires attached to your body. These devices allow your team to monitor your vital signs, drain bodily fluids, take blood, and give medications and fluids.
You will not be able to talk if you have a breathing tube, but it is usually removed within a few days. You may also have a sore throat, which is usually temporary. Tell your care team if you are uncomfortable.
You may move to a hospital room outside the ICU as you recover. This room will probably have equipment to monitor your heart rhythm and vital signs.
A typical hospital stay for endovascular (minimally invasive) surgery is two to five days. Open aortic aneurysm surgery generally requires a hospital stay of seven to 10 days.
Recovery after surgery is a gradual process. Recovery time varies depending on the procedure, type of anesthesia, your general health, age, and other factors. Your doctor may refer you to an exercise rehabilitation program to help you recover. Full recovery takes two weeks to a few months.
Will I feel pain?
Pain control is important for healing and a smooth recovery. There will be discomfort after your surgery. Your doctor will treat your pain so you are comfortable and get the rest you need.
Tell your doctor or care team if your pain gets worse or changes because it may be a sign of a complication.
When should I call my doctor?
It is important to keep all your follow-up appointments after aortic aneurysm repair. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Bloating or pain in your abdomen or belly
Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
Change in alertness, such as passing out, dizziness, unresponsiveness, or confusion
Chest pain, chest tightness, chest pressure, or palpitations
Coughing up blood or yellow or green mucus
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's instructions about when to call for a fever.
Inability to urinate or have a bowel movement
Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot
Pain that is not controlled by your pain medication
Uncontrolled or heavy bleeding
Unexpected drainage, pus, redness or swelling of your incision
How might an aortic aneurysm repair affect my everyday life?
Many people return to an active normal life after aortic aneurysm repair. However, aortic aneurysm repair will not prevent atherosclerosis from coming back. It also will not prevent another area of your aorta from developing an aneurysm.
You can make changes to your everyday life that may help prevent or delay atherosclerosis and reduce the risk of another aneurysm. These include:
Eating a heart-healthy diet
Getting regular exercise
Maintaining a healthy weight
Practicing stress management techniques
Treating other related conditions, including high blood pressure, high cholesterol, and diabetes
You will also have follow-up visits and imaging tests to check on your graft. You may also need additional procedures in the future for maintenance of the graft.
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- Abdominal Aortic Aneurysms. Society of Interventional Radiology. http://www.sirweb.org/patients/abdominal-aortic-aneurysms/
- Aortic Aneurysms. The Society of Thoracic Surgeons. http://www.sts.org/patient-information/aneurysm-surgery/aortic-aneurysms
- Pile, JC. Evaluating postoperative fever: A focused approach. Cleveland Clinic Journal of Medicine. 2006;73 (Suppl 1):S62. http://ccjm.org/content/73/Suppl_1/S62.full.pdf
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- Thoracic Aortic Aneurysm. Society for Vascular Surgery. http://www.vascularweb.org/vascularhealth/Pages/thoracic-aortic-aneurysm.aspx