Abdominal Aortic Aneurysm Repair

(AAA Repair)

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). AAAs are most often caused by atherosclerosis, also known as hardening of arteries, and high blood pressure.

Abdominal Aortic Aneurysm

Abdominal aortic aneurysm
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Reasons for Procedure    TOP

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

  • Causes physical symptoms such as abdominal pain
  • Reaches a size of 2 inches (5 centimeters) across or has been growing rapidly. Smaller aneurysms are watched closely. They are rarely repaired with surgery.
  • Has burst—Requires emergency 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, because of rapid blood loss.

Possible Complications    TOP

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:

  • Problems from general anesthesia, including lightheadedness, low blood pressure, and wheezing
  • Infection
  • Bleeding
  • Damage to organs
  • Death

Some factors that may increase the risk of complications include:

What to Expect    TOP

The procedure varies. It can be done before a rupture as a preventive measure or after a rupture on an emergency basis. The preventive procedure is outlined here.

Prior to Procedure

Imaging or other tests may be done, including:

You may need to stop taking certain medications 1 week before surgery. Talk to your doctor about your regular medications.

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.

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    TOP

This may be done as an open surgery or using an endovascular approach.

In an open surgery, an incision is made from the breastbone to below the belly button. The aorta is clamped slightly above and below the aneurysm. Any blood clot on the inside of the aorta is removed. An artificial wall 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.

For the endovascular repair, a small incision will be made in your leg. A sleeve will be inserted in this incision and into the aorta. It will be advanced to the aneurysm. The sleeve will take pressure off the wall and prevent it from expanding or leaking. The incision will then be closed.

Abdominal Aortic Aneurysm Surgery

AAA repair
An artificial graft is stitched to the aorta.
Copyright © Nucleus Medical Media, Inc.

How Long Will It Take?    TOP

About 4-6 hours

How Much Will It Hurt?    TOP

Anesthesia prevents pain during the procedure. Most people will be sore after the procedure and will be given pain medications.

Average Hospital Stay    TOP

The length of your hospital stay depends on your overall condition. Ask your doctor how long you should plan to stay.

Post-procedure Care    TOP

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:
    • IV—provides medications and fluids
    • 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

At Home

To help prevent further problems, you and your doctor will need to work to increase your overall health. This can be done with medications and a healthy lifestyle. If you are a smoker, you should talk to your doctor about quitting.

Recovery takes about 6 weeks. If you had symptoms from the AAA 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.

Call Your Doctor    TOP

Call your doctor if any of the following occur:

  • 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
  • Persistent nausea or vomiting
  • Abdominal cramps or diarrhea
  • Unusual fatigue or depression
  • Disorientation or confusion
  • Numbness or tingling in the legs
  • New or unexpected
  • Cough, shortness of breath, or chest pain

If you think you are having an emergency, call for emergency medical services right away.

RESOURCES:

American Heart Association
http://www.heart.org
Society for Vascular Surgery
https://vascular.org

CANADIAN RESOURCES:

Heart and Stroke Foundation of Canada
http://www.heartandstroke.ca
University of Ottawa Heart Institute
https://www.ottawaheart.ca

References:

Abdominal aortic aneurysm (AAA). EBSCO DynaMed Plus website. Available at: http://www.dynamed.... Updated January 11, 2018. Accessed March 1, 2018.
Abdominal aortic aneurysm repair. Johns Hopkins Medicine website. Available at: https://www.hopkinsmedicine.org/healthlibrary/test_procedures/cardiovascular/abdominal_aortic_aneurysm_repair_92,P08291. Accessed March 1, 2018.
Aneurysm repair. The Texas Heart Institute website. Available at: https://www.texasheart.org/heart-health/heart-information-center/topics/aneurysm-repair. Accessed March 1, 2018.
Hall SW. Endovascular repair of abdominal aortic aneurysms (Home Study Program). AORN Journal. 2003;77(3):630-642.
6/2/2011 DynaMed Plus Systematic Literature Surveillance http://www.dynamed...: 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.
7/17/2017 DynaMed Plus Systematic Literature Surveillance http://www.dynamed...: Reis SP, Majdalany BS, Ali F, et al. ACR Appropriateness Criteria for pulsatile abdominal mass, suspected abdominal aortic aneurysm. Available at: https://acsearch.acr.org/docs/69414/Narrative. Updated 2016.
Last reviewed March 2018 by EBSCO Medical Review Board Michael J. Fucci, DO, FACC
Last Updated: 7/17/2017

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