Abdominal Aortic Aneurysm Repair

The abdominal aorta is the portion of the aorta (the largest blood vessel in the body) that carries blood to the abdomen, pelvis, and legs. Sometimes the walls of this part of the aorta weaken and bulge in one area, which creates an abdominal aortic aneurysm (AAA). Abdominal aortic aneurysms are most often a result of atherosclerosis combined with high blood pressure. If the AAA becomes large or ruptures, surgery is necessary.

Parts of the Body Involved

Torso, abdominal area

Reasons for Procedure

Surgery to repair an AAA is done in these cases:
  • The aneurysm is causing physical symptoms, such as abdominal pain.
  • The aneurysm has reached a size of 5 cm across, or has been growing steadily by 1+ cm for 6-12 months. Aneurysms that are less than 5 cm are monitored closely, but are usually not surgically repaired.
  • The aneurysm has ruptured. Symptoms of rupture include sudden, excruciating pain in the back or lower abdomen, and low blood pressure, sometimes leading to shock. Surgery must be done immediately, or the rupture can be fatal.

Risk Factors for Complications during the Procedur

As with any surgery, there is a risk of infection, bleeding, or complications from general anesthesia.

What to Expect

The procedure varies, depending on whether it is performed before a rupture (preventive) or after a rupture (emergency). The preventive procedure is outlined here.

Prior to Procedure

Your doctor will likely do some or all of the following:

  • CT scan of the abdomen
  • Magnetic resonance imaging (MRI)
  • Abdominal ultrasound
  • Electrocardiogram (EKG)
  • Chest x-ray

The day of the surgery, you will be given an antibiotic intravenously (in the vein). You may also be given a laxative or enema to clear the colon.

During Procedure – IV fluids and antibiotics, anesthesia

Anesthesia – General

Description of the Procedure - An incision is made from the breastbone to below the belly button. The doctor clamps the aorta slightly above and below the aneurysm. The blood clot on the inside of the aneurysm is removed, and small openings in the aneurysm wall are repaired. The aneurysm is removed and an artificial graft made of Dacron is stitched to the normal aorta on either side of where the aneurysm had been. Then the clamps are removed, and the wound is closed with stitches.

After Procedure – You will be sent to the intensive care unit for care and monitoring. You will have catheters in place, including the following:

  • Urinary catheter – monitors urine output
  • Arterial catheter – monitors blood pressure
  • Central venous catheter – monitors pressure in the heart
  • Epidural catheter – provides pain medication
  • Nasogastric tube – inserted through the nose and into the stomach to remove secretions and provide nutrition until your intestines regain normal function

How Long Will It Take? 4-6 hours

Will It Hurt? Anesthesia prevents pain during the procedure.

Possible Complications:

  • Excessive bleeding
  • Injury to the ureters
  • Kidney failure
  • Decreased blood supply to the spinal cord
  • Death

Average Hospital Stay – This varies and will be determined by your doctor.

Postoperative Care – After surgery, you may gradually return to normal activities. To prevent further circulatory problems, you will need to manage any risk factors or conditions, such as atherosclerosis and high blood pressure, with medications and a healthful lifestyle.

Outcome

Preventive AAA surgery generally has a good outcome for people who are relatively healthy. Emergency surgery to fix an AAA rupture has a 50% survival rate, due to the rapid loss of blood.

Call Your Doctor If Any of the Following Occurs

  • Signs of infection, including fever and chills.
  • Redness, swelling, increasing pain, excessive bleeding, or discharge at the incision site.
  • Cough, shortness of breath, chest pain, or severe nausea or vomiting.
  • Pain, burning, urgency or frequency of urination, or persistent bleeding in the urine.