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Abdominal Aortic Aneurysm Repair
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Abdominal Aortic Aneurysm Repair

(AAA Repair)

En Español (Spanish Version)

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). AAA's are most often caused by atherosclerosis (hardening of arteries) and high blood pressure .

Abdominal Aortic Aneurysm

Abdominal aortic aneurysm

© 2011 Nucleus Medical Media, Inc.

Reasons for Procedure

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

  • Causes physical symptoms (eg, abdominal pain)
  • Reaches a size of five centimeters (about two inches) across or has been growing rapidly—Smaller aneurysms are watched closely. They are rarely repaired with surgery.
  • Has burst—Surgery must be done immediately.

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 (eg, light-headedness, low blood pressure, wheezing)
  • Infection
  • Bleeding
  • Damage to organs
  • Death

Some factors that may increase the risk of complications include:

What to Expect

The procedure varies. It can be done before a rupture (preventive) or after a rupture (emergency). The preventive procedure is outlined here.

Prior to Procedure

Your doctor will likely do some of the following:

  • CT scan —a type of x-ray that uses a computer to make pictures of structures inside the abdomen
  • MRI scan —a test that uses magnetic waves to make pictures of structures inside the abdomen
  • Abdominal ultrasound —a test that uses sound waves to examine organs in the abdomen
  • Electrocardiogram (ECG, EKG)—a test that records the heart's activity by measuring electrical currents through the heart muscle
  • Chest x-ray —a photograph-like image of the heart and lungs that uses a small dose of radiation to create a picture

Your doctor may also 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. Talk to your doctor about your regular medicine, especially:
    • Aspirin and other nonsteroidal anti-inflammatory drugs (eg, ibuprofen, naproxen)
    • Blood-thinning drugs, such as warfarin (Coumadin)
    • Anti-platelet drugs, such as clopidogrel (Plavix)

On the day of the procedure, you will be given an antibiotic by IV (a needle in your hand or arm). 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 made of Dacron 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

AAA repair

An artificial graft is stitched to the aorta.

© 2011 Nucleus Medical Media, Inc.

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

This varies depending 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:
    • 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 healthful 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 911 .

RESOURCES:

American Heart Association
www.americanheart.org/

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

CANADIAN RESOURCES:

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

University of Ottawa Heart Institute
http://www.ottawaheart.ca/

References:

Abdominal Aortic Aneurysm (AAA). American Academy of Family Physicians. Family Doctor.org website. Available at: http://familydoctor.org/online/famdocen/home/articles/883.html . Updated July 2010. Accessed November 1, 2010.

Aneurysm, aortic. American Heart Association Web site. Available at: http://www.americanheart.org . Accessed June 3, 2008.

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.



Last reviewed September 2010 by Arun Kalyanasundaram, MD, MPH


Last updated Updated: 6/2/2011

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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