Abdominal Aortic Aneurysm

Problem: AAA

Arteries are blood vessels that carry oxygen-rich blood from the heart to the rest of the body. The aorta, the largest artery in the body, carries blood directly from the heart to smaller arteries that branch off of it. The smaller arteries carry the blood to the rest of the body. The lower portion of the aorta is called the abdominal aorta. Important smaller arteries such as the renal arteries, which supply the kidneys, and the iliac arteries, which supply the legs, branch off of the abdominal aorta. Normally the inside of the aorta is smooth, like any healthy artery. This allows blood to flow smoothly and easily through the artery. Sometimes the walls of an artery can weaken and expand, resulting in an aneurysm. If an aneurysm occurs in the abdominal aorta, it is known as an AAA.

Anyone can develop an AAA, but there are certain factors that make someone more prone to have one. These include smoking, high blood pressure, family history of AAA, and age. An AAA usually does not cause any symptoms, so it is typically found during a routine exam or when testing is done for another problem. Should the AAA rupture, major bleeding and even death can occur. Once it is discovered, there are tests such as ultrasounds and CT scans to monitor the growth and size of the AAA. We will closely follow your AAA because of the threat of rupture – the larger the AAA the greater the chances of rupture.

Treatment

If an AAA is growing quickly or reaches a size greater than 5 centimeters, surgical repair of the aneurysm is recommended because of the risk of rupture. There are two types of surgery to treat an AAA: open surgery and endovascular repair. Both procedures have their own benefits and risks, and certain factors may make one option better than the other. Dr. Robbins will consider all factors before recommending one of these procedures. Some of the benefits and risks of each surgery are listed below.

Open Surgery

During open surgery, Dr. Robbins replaces the expanded portion of the abdominal aorta with a graft. The graft is made of a strong, flexible fabric that allows blood to flow through it safely. First you will be given general anesthesia, meaning you will be asleep and pain-free during the surgery. Dr. Robbins will next make an incision in your abdomen. After he moves aside the abdominal organs, Dr. Robbins clamps the aorta so that blood flow stops. Next an incision is made in the aneurysm. The graft is sewn to the aorta both above and below the aneurysm after any blood clots are cleaned out. Dr. Robbins may remove part of the aorta so that it can be closed snugly around the graft. By sewing the aorta around the graft, the graft is protected and reinforced. After the aorta is closed, the clamps are removed and all incisions closed.

Following the surgery, you will be taken to the ICU to begin your recovery. In the ICU, your vital signs will be monitored to make sure you are recovering well. Once you are able, it is encouraged that you walk around to gain strength, prevent blood clots, and aid the digestive system in its return to normal function. The overall recovery process will take from 5 to 10 days in the hospital and anywhere from 4 weeks to a few months after you return home. Some basic instructions for when you go home are given below.

Endovascular Repair

During endovascular repair, Dr. Robbins places a graft inside the abdominal aorta. The graft is made of mesh and fabric. Usually general anesthesia is given, so you will be asleep and pain-free during the surgery. Dr. Robbins makes who small incisions, one in each side of the groin. A long, thin tube called a catheter is inserted into an artery at each incision. The graft is collapsed inside one of the catheters. X-ray guidance is used to guide the catheters to the abdominal aorta. Once they reach the aneurysm, the catheters are used to place the graft. After it is in position, Dr. Robbins expands the graft, using metal hooks or springs to keep the graft in place above and below the aneurysm. Once the graft is secured, the catheters are withdrawn and the incisions closed.

Following the surgery, you will be taken to your hospital room. Your vital signs will be monitored and some tests may be done to make sure the graft is working properly. Your hospital stay will probably be between 1 to 3 days. Some basic instructions for when you go home are given below.

Preparing for Your Procedure

You will be told by our office how to prepare for your procedure. This includes special instructions about medications. Be sure to follow the instructions we give you, or your surgery may have to be canceled.

A Week Before

  • Tell us about any allergies you have.
  • Tell us about any medications you take, including prescriptions, over-the-counter medications, supplements, and herbs.
  • Make medication changes as we direct you. This can involve stopping certain medications you normally take or starting certain medications before surgery.

The Day Before

  • Don’t drink or eat after midnight the night before you surgery. Do not smoke, chew tobacco, or chew gum after midnight. If you were instructed to continue any medications, take them with a sip of water only.
  • Arrange a ride home for when your recovery is finished.
  • Follow any special instructions we give you.

The Day of the Procedure

  • Arrive on time to the hospital.
  • Bring all medications you take with you to the hospital.
  • Hospital staff will prepare you for the procedure.

Recovery

         Your recovery time and discharge depend on the type of AAA repair you have. You will receive specific instructions about your home recovery when you are discharged from the hospital, but some basic guidelines are:

  • Keep the incision or puncture site clean and dry.
  • Take medications as prescribed.
  • Do not drive until cleared to do so.
  • Avoid strenuous exercise and lifting objects more than 10 pounds anywhere from 1 to 6 weeks depending on the type of repair you ha

When to Call VascularTyler

Call our office if you experience any of the following during or after your procedure:

·      Changes in color or temperature of the legs or feet

·      Fever

·      Arm or leg turns blue, swells, or feels cold

·      Chest pain or trouble breathing

·      Bleeding or swelling at the incision site

·      Stomach, abdomen, or lower back pain