Surgery for Abdominal Aortic Aneurysm – 2 repair options

Surgery for Abdominal Aortic Aneurysm- What are the repair procedures

Surgery for Abdominal Aortic Aneurysm constitutes two procedures

Abdominal Aortic Aneurysm Endograft Repair

Abdominal aortic aneurysm endograft repair is a surgery to fix an aortic aneurysm in the abdominal area. An aneurysm is a weak or damaged part of an artery wall that bulges out from the normal force of blood pumping through the body.

An abdominal aortic aneurysm is an aneurysm that happens in the lower part of the aorta, which is the main artery of the body.

The repair is often done if the aneurysm gets so large that it might burst (rupture). A ruptured aneurysm would cause bleeding inside the body that could put a person’s life in danger. Before that happens, this procedure is needed to fix the problem.

The procedure may also be done if the aneurysm causes symptoms such as pain in the back, abdomen, or side. In this procedure, a tube made of fabric and metal mesh (endograftorstent-graft) is placed in the weak part of the aorta to repair it.

Tell a health care provider about:

  • Any allergies you have.
  • All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
  • Any problems you or family members have had with anesthetic medicines.
  • Any blood disorders you have.
  • Any surgeries you have had.
  • Any medical conditions you have.
  • Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

  • Infection of the graft or incision area.
  • Bleeding during the procedure or from the incision site.
  • Allergic reactions to medicines.
  • Damage to other structures or organs.
  • Blood leaking out around the endograft.
  • The endograft moving from where it was placed during surgery.
  • Blood flow through the graft becoming blocked.
  • Blood clots.
  • Kidney problems.
  • Blood flow to the legs becoming blocked (rare).
  • Rupture of the aorta even after the endograft repair is a success (rare).

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

  • Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

  • 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
  • 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
  • 6 hours before the procedure – stop drinking milk or drinks that contain milk.
  • 2 hours before the procedure – stop drinking clear liquids.

Medicines

  • Ask your health care provider about:
    • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
    • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood.Do nottake these medicines before your procedure if your health care provider instructs you not to.
  • You may be given antibiotic medicine to help prevent infection.

General instructions

  • You may need to have blood tests, a test to check heart rhythm (electrocardiogram,or ECG), or a test to check blood flow (angiogram) before the surgery.
  • Imaging tests will be done to check the size and location of the aneurysm. These tests could include an ultrasound, a CT scan, or an MRI.
  • Do notuse any products that contain nicotine or tobacco—such as cigarettes and e-cigarettes—for as long as possible before the surgery. If you need help quitting, ask your health care provider.
  • Ask your health care provider how your surgical site will be marked or identified.
  • Plan to have someone take you home from the hospital or clinic.

What happens during the procedure?

  • To reduce your risk of infection:
    • Your health care team will wash or sanitize their hands.
    • Your skin will be washed with soap.
    • Hair may be removed from the surgical area.
  • An IV tube will be inserted into one of your veins.
  • You will be given one or more of the following:
    • A medicine to help you relax (sedative).
    • A medicine to numb the area (local anesthetic).
    • A medicine to make you fall asleep (general anesthetic).
    • A medicine that is injected into an area of your body to numb everything below the injection site (regional anesthetic).
  • During the surgery:
    • Small incisions or a puncture will be made on one or both sides of the groin. Long, thin tubes (catheters) will be passed through the opening, put into the artery in your thigh, and moved up into the aneurysm in the aorta.
    • The health care provider will use live X-ray pictures to guide the endograft through the catheter to the place where the aneurysm is.
    • The endograft will be released to seal off the aneurysm and to line the aorta. It will keep blood from flowing into the aneurysm and will help keep it from rupturing. The endograft will stay in place and will not be taken out.
    • X-rays will be used to check where the endograft is placed and to make sure that it is where it should be.
    • The catheter will be taken out, and the incision will be closed with stitches (sutures).

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

  • Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
  • You will need to lie flat for a number of hours. Bending your legs can cause them to bleed and swell.
  • You will then be urged to get up and move around a number of times each day and to slowly become more active.
  • You will be given medicines to control pain.
  • Certain tests may be done after your procedure to check how well the endograft is working and to check its placement.
  • Do not drive for 24 hours if you received a sedative.

Abdominal Aortic Aneurysm Endograft Repair, Care After

What can I expect after the procedure?

After the procedure, it is common to have:

  • Pain or soreness at the incision site.
  • Tiredness (fatigue).

Follow these instructions at home:

Activity

  • Get plenty of rest.
  • Follow instructions from your health care provider about how much you should move around and how far you should go when you take short walks. Start walking farther when your health care provider says it is okay.
  • Limit your activities as told by your health care provider.
  • Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.

Incision care

  • Follow instructions from your health care provider about how to take care of your incisions. Make sure you:
    • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
    • Change your dressing as told by your health care provider.
    • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do notremove adhesive strips completely unless your health care provider tells you to do that.
  • Keep the incision area clean and dry.
  • Do nottake baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you can take showers. You may only be allowed to take sponge baths for bathing.
  • Check your incision area every day for signs of infection. Check for:
    • More redness, swelling, or pain.
    • More fluid or blood.
    • Warmth.
    • Pus or a bad smell.

Lifestyle

  • Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
  • Make any other lifestyle changes that your health care provider suggests. These may include:
    • Keeping your blood pressure under control.
    • Finding ways to lower stress.
    • Eating healthy foods that are good for your heart, such as vegetables, fruits, and whole grains that add fiber to your diet.
    • Getting regular exercise.

General instructions

  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

  • You have pain in your abdomen, chest, or back.
  • You have more redness, swelling, or pain around an incision.
  • You have more fluid or blood coming from an incision.
  • Your incision feels warm to the touch.
  • You have pus or a bad smell coming from an incision.
  • You have a fever.

Get help right away if:

  • You have trouble breathing.
  • You suddenly have pain in your legs or you have trouble moving either of your legs.
  • You faint or you feel very light-headed.

Abdominal Aortic Aneurysm Open Repair

Abdominal aortic aneurysm open repair is a surgery to fix an aortic aneurysm in the abdominal area. An aneurysm is a weak or damaged part of an artery wall that bulges out from the normal force of blood pumping through the body. An abdominal aortic aneurysm is an aneurysm that happens in the lower part of the aorta, which is the main artery of the body.

Surgery is often done if there is a high risk that the aneurysm might burst (rupture). The bigger the aneurysm gets, the more chance there is that it will rupture. A ruptured aneurysm can cause bleeding inside the body that could put a person’s life in danger. Before that happens, surgery is needed to fix the problem.

Surgery may also be done if the aneurysm causes symptoms such as pain in the back, abdomen, or side. In abdominal aortic aneurysm open repair, a tube-shaped piece of man-made material (aortic graft) is placed in the damaged or weak part of the aorta to repair it.

Tell a health care provider about:

  • Any allergies you have.
  • All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
  • Any problems you or family members have had with anesthetic medicines.
  • Any blood disorders you have.
  • Any surgeries you have had.
  • Any medical conditions you have, including any recent symptoms of colds or infections.
  • Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

  • Infection.
  • Bleeding.
  • Allergic reactions to medicines.
  • Lung problems.
  • Intestine problems.
  • Heart attack.
  • Blood clots.
  • Very low blood pressure.
  • Kidney damage.
  • Nerve damage that can cause pain or numbness in the leg.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

  • Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

  • 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
  • 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
  • 6 hours before the procedure – stop drinking milk or drinks that contain milk.
  • 2 hours before the procedure – stop drinking clear liquids.

Medicines

  • Ask your health care provider about:
    • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
    • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.
  • You may be given antibiotic medicine to help prevent infection.
  • You may be given medicine that causes you to have bowel movements. It is important to empty the intestines before this surgery.

General instructions

  • You may need to have blood tests, a test to check heart rhythm (electrocardiogram,or ECG), or a test to check blood flow (angiogram) before the surgery.
  • Imaging tests will be done to check the size and location of the aneurysm. These tests could include an ultrasound, a CT scan, or an MRI.
  • Do notuse any products that contain nicotine or tobacco—such as cigarettes and e-cigarettes—for as long as possible before the surgery. If you need help quitting, ask your health care provider.
  • Ask your health care provider how your surgical site will be marked or identified.
  • Plan to have someone take you home from the hospital or clinic.

What happens during the procedure?

  • To reduce your risk of infection:
    • Your health care team will wash or sanitize their hands.
    • Your skin will be washed with soap.
    • Hair may be removed from the surgical area.
  • An IV tube will be inserted into one of your veins.
  • You will be given a medicine to make you fall asleep (general anesthetic).
  • A thin tube (catheter) will be placed in your bladder to drain urine during and after surgery.
  • A small tube (epidural catheter) may be placed into your lower spine. It will be used to give pain medicine during and after surgery.
  • The surgeon will make an incision in your abdomen in the area of the aneurysm.
  • Clamps will be put on the abdominal aorta. One will be put above the aneurysm, and one will be put below it. This will stop the blood flow.
  • Next, the surgeon will open the aneurysm and then:
    • Sew the graft to healthy parts of the aorta, right above and below the aneurysm.
    • Wrap the walls of the open aneurysm around the graft.
    • Sew the artery closed.
  • The clamps will be removed. This will let the blood flow again.
  • The incision will be closed using stitches (sutures) or staples. It will then be covered with a bandage (dressing).

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

  • Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
  • Your IV access tube and urinary catheter will stay in place for a few days. They will be taken out once your body is doing its normal functions such as urinating.
  • You may be given pain medicine through the epidural catheter for a few days.
  • You might also have a tube that runs through your nose into the stomach to remove fluids. Once the intestines are working again, the tube in the nose will be taken out. This usually happens in 2–3 days.
  • A number of tests may be done to check your condition and the repaired aorta. These might include X-rays, an ECG, or an ultrasound.
  • You may be asked to cough and to do deep breathing exercises often. This helps keep you from getting a lung infection.
  • You may have to wear compression stockings. These stockings help to prevent blood clots and reduce swelling in your legs.

Abdominal Aortic Aneurysm Open Repair, Care After

What can I expect after the procedure?

After the procedure, it is common to have:

  • Some pain at the incision site.
  • Tiredness (fatigue). It can take up to 3 months before you are ready to start all of your normal activities.

Follow these instructions at home:

Activity

  • Get plenty of rest.
  • Follow instructions from your health care provider about how much you should move around and how far you should go when you take short walks. Start walking farther when your health care provider says it is okay.
  • Avoid activities that require a lot of energy for 6–8 weeks or for as long as told by your health care provider.
  • Do not lift anything that is heavier than 10 lb (4.5 kg) until your health care provider says it is safe.
  • Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
  • Do not drive until your health care provider says it is okay.

Incision care

  • Follow instructions from your health care provider about how to take care of your incision. Make sure you:
    • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
    • Change your dressing as told by your health care provider.
    • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do notremove adhesive strips completely unless your health care provider tells you to do that.
  • Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you can take showers. You may only be allowed to take sponge baths for bathing.
  • Check your incision area every day for signs of infection. Check for:
    • More redness, swelling, or pain.
    • More fluid or blood.
    • Warmth.
    • Pus or a bad smell

Lifestyle

  • Do notuse any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
  • Make any other lifestyle changes that your health care provider suggests. These may include:
    • Keeping your blood pressure under control.
    • Finding ways to lower stress.
    • Eating healthy foods that are good for your heart, such as vegetables, fruits, and whole grains that add fiber to your diet.
    • Getting regular exercise.

General instructions

  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Drink enough fluid to keep your urine clear or pale yellow.
  • Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

  • You have more redness, swelling, or pain around your incision.
  • You have more fluid or blood coming from your incision.
  • Your incision feels warm to the touch.
  • You have pus or a bad smell coming from your incision.
  • You have a fever.
  • You have chills.
  • You notice that the edges of the incision are not staying together after the stitches or staples have been taken out.
  • You have nausea or vomiting that does not go away.
  • You have a rash.

Get help right away if:

  • You feel dizzy when standing or you faint.
  • You have trouble breathing.
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