Aneurysmectomy

(Aortic Aneurysm Repair/Removal)

Aneurysmectomy – Definition

The aorta is the largest artery in the body. It begins at the heart and runs through the chest and abdomen. Sometimes the walls of the aorta weaken and bulge in one area. An aortic repair is a surgery to create a support for the weakened area.

Aneurysmectomy – Reasons for Procedure

• To prevent rupture (bursting) of an aneurysm, which causes severe, life-threatening bleeding
• To remove a ruptured aneurysm and repair the damaged aorta

Aneurysmectomy – Possible Complications

If you are planning to have an aortic aneurysm repair, 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
• Blood clot formation
• Damage to organs or tissue
• Death

Factors that may increase the risk of complications include:

• Smoking
• Emergency surgery due to a burst aneurysm
• Heart disease
• Previous episodes of transient ischemic attacks or strokes
• Lung disease
• Debilitation due to cancer
• Diabetes
• Obesity

Aneurysmectomy – What to Expect

Prior to Procedure

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

• Physical exam
• Blood tests
• Your doctor may need detailed pictures of your body. These can be made with:
  • X-rays
  • Ultrasound
  • CT scan
  • MRI scan
• Cardiac catheterization
• Electrocardiogram

Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:

• Aspirin or other anti-inflammatory drugs
• Blood thinners, such as clopidogrel (Plavix) or warfarin (Coumadin)

Leading up to your procedure:

• The night before, eat a light meal. Do not eat or drink anything after midnight.
• You may be given laxatives and/or an enema to empty your intestines.
• You may be asked to shower the morning of your procedure. You may be given special antibacterial soap to use.
• Arrange for help at home after returning from the hospital.
• Arrange for a ride to and from the procedure.

Aneurysmectomy – Anesthesia

General anesthesia will be used. You will be asleep.

Aneurysmectomy – Description of Procedure

Depending on the location of the aneurysm, blood flow may need to be passed to a heart-lung machine. The machine will temporarily do the jobs of the heart and lungs.

An incision will be made over the area of the aneurysm. This may be in the abdomen or chest. The aorta will be clamped off above and below the aneurysm. The doctor will open the aneurysm and clean out any debris. The graft will be sewn into place to reconnect the two ends of the aorta. The tissue of the aneurysm will then be wrapped around the outside of the graft.

When the graft is properly in place, the clamps will be released. This will allow blood flow to resume through the aorta. The incision will be closed, using either stitches or staples. The area will be covered with a sterile dressing.

Some aneurysms can be repaired without a large abdominal incision (percutaneously). Instead, punctures are made in the arteries in the groin. Not all patients are suited for this procedure. Your doctor will discuss your options with you.

Aneurysmectomy – Immediately After Procedure

You will be brought to a recovery room after surgery. You will be monitored there for any negative effects from the surgery or anesthesia.

Aneurysmectomy – How Long Will It Take?

One hour to a few hours

Aneurysmectomy – How Much Will It Hurt?

Anesthesia prevents pain during surgery. The incision will cause some pain after the surgery. Talk to your doctor about medicines to help you manage the pain.

Aneurysmectomy – Average Hospital Stay

The usual length of stay is 4-7 days. Your doctor may choose to keep you longer if complications happen.

Aneurysmectomy – Postoperative Care

At the Hospital

• You will need to stay in the intensive care unit for the first day or so after surgery. You will then be moved to a regular hospital room.
• For the first day or two, you will be hooked up to monitors to track your heart rate, breathing, blood pressure, and blood oxygen levels. Your doctor may also order blood tests, chest x-rays, EKG, and an ultrasound of the repaired area of the aorta.
• You may have some 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
• You may be asked to use an incentive spirometer, to breathe deeply, and to cough frequently. This will help improve lung function after general anesthesia.
• You may be given special compression stockings to wear after surgery. They may help decrease the possibility of blood clots forming in your legs.

At Home

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

• Follow any discharge instructions to care for the wound.
• Ask your doctor when it is safe to shower, bathe, or soak in water.
• 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.

Recovery takes about six weeks. If you had symptoms from your aneurysm before the surgery, you may notice some improvements in your health. You may find you have more strength and less swelling in your legs. You may also have lower blood pressure, improved energy, and absence of pain from the aneurysm.

Aneurysmectomy – Call Your Doctor

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

• Signs of infection, including fever and chills
• Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
• Pain or swelling in your abdomen
• Nausea and/or vomiting that you cannot control with the medicines you were given after surgery, or which persist for more than two days after discharge from the hospital
• Pain that you cannot control with the medicines you have been given
• Pain, burning, urgency or frequency of urination, or persistent bleeding in the urine
• Cough, shortness of breath, or chest pain
• Pain or swelling in your feet, calves, or legs
• In case of an emergency, call for medical help right away.