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.

Abdominal Aortic Aneurysm Repair

(AAA Repair)
by Editorial Staff and Contributors
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 .

Reasons for Procedure

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

  • Causes physical symptoms (eg, abdominal pain)
  • Has burst—Surgery must be done immediately.
  • 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.

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:

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

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:

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

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:
    • Anti-platelet drugs, such as clopidogrel (Plavix)
    • Blood-thinning drugs, such as warfarin (Coumadin)
    • Aspirin and other nonsteroidal anti-inflammatory drugs (eg, ibuprofen , naproxen )

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.

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 have tubes in place, which may include the following:
    • 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
    • Urinary catheter—monitors urine output
  • You will be sent to the intensive care unit for monitoring.
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:

  • Abdominal cramps or diarrhea
  • Unusual fatigue or depression
  • Any change of color or sensation in your legs or feet
  • Back pain
  • Burning, pain, or problems when urinating
  • Cough, shortness of breath, or chest pain
  • Disorientation or confusion
  • Nausea or vomiting
  • New abdominal pain
  • New, unexplained symptoms
  • Numbness or tingling in the legs
  • Redness, swelling, increasing pain, excessive bleeding, or discharge at the incision site
  • Signs of infection, including fever and chills

In case of an emergency, call for medical help right away.

Last reviewed: September 2011 by Michael J. Fucci, DO.

RESOURCES:
CANADIAN RESOURCES:
References: