EVAR; Endovascular aneurysm repair – aorta; AAA repair – endovascular; Repair – aortic aneurysm – endovascular
Endovascular abdominal aortic aneurysm repair is surgery to repair a widened area in your aorta. This is called an aneurysm. The aorta is the large artery that carries blood to your belly, pelvis, and legs.
An aortic aneurysm is when a part of this artery becomes too large or balloons outward. It occurs due to weakness in the wall of the artery.
Description
This procedure is done in an operating room, in the radiology department of the hospital, or in a catheterization lab. You will lie on a padded table. You may receive general anesthesia (you are asleep and pain-free) or epidural or spinal anesthesia.
- Your doctor will make a small surgical cut near the groin, to find the femoral artery. Then your doctor will insert a stent (a metal coil) and a manmade (synthetic) graft through the cut into the artery.
- The doctor uses x-rays to guide the stent graft up into your aorta, to where the aneurysm is located. The doctor will open the stent using a spring-like mechanism and attach it to the walls of the aorta. Your aneurysm will eventually shrink around it.
- The doctor will then use x-rays again to make sure the stent is in the right place and your aneurysm is not bleeding inside your body.
Why the Procedure Is Performed
Endovascular aortic repair is done because your aneurysm is very large, growing quickly, or is leaking or bleeding.
You may have an abdominal aortic aneurysm that is not causing any symptoms or problems. Your doctor may have found out about this problem when you had an ultrasound or CT scan for another reason. There is a risk that this aneurysm may open up (rupture) if you do not have surgery to repair it. However, surgery to repair the aneurysm may also be risky. In such cases, endovascular repair is an option.
You and your doctor must decide whether the risk of having this surgery is smaller than the risk of rupture if you do not have surgery to repair the problem. The doctor is more likely to recommend that you have surgery if the aneurysm is:
- Larger (about 2 inches or 5 centimeters)
- Growing more quickly (a little less than 1/4 inch or 1/2 centimeter over the last 6 to 12 months)
Endovascular repair has a lower risk of complications compared to open surgery. Your doctor is more likely to suggest this type of repair if you have other serious medical problems or are elderly.
Risks
Risks for any surgery are:
- Blood clots in the legs that may travel to the lungs
- Breathing problems
- Infection, including in the lungs, urinary tract, and belly
- Heart attack or stroke
- Reactions to medicines
Risks for this surgery are:
- Bleeding around the graft that needs more surgery
- Bleeding before or after procedure
- Blockage of the stent
- Damage to a nerve, causing weakness, pain, or numbness in the leg
- Kidney failure
- Poor blood supply to your legs, your kidneys, or other organs
- Problems getting or keeping an erection
- Surgery is not successful and you need open surgery
- The stent slips
Before the Procedure
Your health care provider will examine you and order tests before you have surgery.
Always tell your provider what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.
If you are a smoker, you should stop. Your provider can help. Here are other things you will need to do before your surgery:
- About two weeks before your surgery, you will visit your provider to make sure any medical problems, such as diabetes, high blood pressure , and heart or lung problems, are well treated.
- You also may be asked to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), clopidogrel (Plavix), warfarin (Coumadin), and naprosyn (Aleve, Naproxen).
- Ask which drugs you should still take on the day of your surgery.
- Always tell your provider if you get a cold, flu, fever, herpes breakout, or other illness before your surgery.
The evening before your surgery:
- DO NOT drink anything after midnight, including water.
On the day of your surgery:
- Take any medicines your doctor told you to take with a small sip of water.
- You will be told when to arrive at the hospital.
After the Procedure
Most people stay in the hospital for 3 to 5 days after this surgery, depending on the type of procedure they had. Most often, the recovery from this procedure is faster and with less pain than with open surgery. Also, you will most likely be able to go home sooner.
During a hospital stay, you may:
- Be in the intensive care unit (ICU), where you will be watched very closely at first
- Have a urinary catheter
- Be given medicines to thin your blood
- Be encouraged to sit on the side of your bed and then walk
- Wear special stockings to prevent blood clots in your legs
- Receive pain medicine into your veins or into the space that surrounds your spinal cord (epidural)
Abdominal aortic aneurysm repair – open
AAA – open; Repair – aortic aneurysm – open
Open abdominal aortic aneurysm repair is surgery to fix a widened part in your aorta. This is called an aneurysm. The aorta is the large artery that carries blood to your belly (abdomen), pelvis, and legs.
An aortic aneurysm is when part of this artery becomes too large or balloons outward.
Description
The surgery will take place in an operating room. You will be given general anesthesia (you will be asleep and pain-free).
Your surgeon opens up your belly and replaces the aortic aneurysm with a man-made, cloth-like material.
Here is how it can be done:
- In one approach, you will lie on your back. The surgeon will make a cut in the middle of your belly, from just below the breastbone to below the belly button. Rarely, the cut goes across the belly.
- In another approach, you will lie slightly tilted on your right side. The surgeon will make a 5- to 6-inch (13 to 15 centimeters) cut from the left side of your belly, ending a little below your belly button.
- Your surgeon will replace the aneurysm with a long tube made of man-made (synthetic) cloth. It is sewn in with stitches.
- In some cases, the ends of this tube (or graft) will be moved through blood vessels in each groin and attached to those in the leg.
- Once the surgery is done, your legs will be examined to make sure that there is a pulse.
- The cut is closed with sutures or staples.
Surgery for aortic aneurysm replacement may take 2 to 4 hours. Most people recover in the intensive care unit (ICU) after the surgery.
Why the Procedure Is Performed
Open surgery to repair an abdominal aortic aneurysm is sometimes done as an emergency procedure when there is bleeding inside your body from the aneurysm.
You may have an abdominal aortic aneurysm that is not causing any symptoms or problems. Your health care provider may have found the problem after you had an ultrasound or CT scan done for another reason. There is a risk that this aneurysm may suddenly break open (rupture) if you do not have surgery to repair it. However, surgery to repair the aneurysm may also be risky, depending on your overall health.
You and your provider must decide whether the risk of having this surgery is smaller than the risk of rupture. Surgery is more likely to be recommended if the aneurysm is:
- Larger (about 2 inches or 5 cm)
- Growing more quickly (a little less than 1/4 inch or 1/2 centimeter over the last 6 to 12 months)
Risks
The risks for this surgery are higher if you have:
- Heart disease
- Kidney failure
- Lung disease
- Past stroke
- Other serious medical problems
Risks of problems or complications are also higher for older people.
Risks for any surgery are:
- Blood clots in the legs that may travel to the lungs
- Breathing problems
- Heart attack or stroke
- Infection, including in the lungs ( pneumonia ), urinary tract, and belly
- Reactions to medicines
Risks for this surgery are:
- Bleeding before or after surgery
- Damage to a nerve, causing pain or numbness in the leg
- Damage to your intestines or other nearby organs
- Infection of the graft
- Injury to the ureter, the tube that carries urine from your kidneys to your bladder
- Lower sex drive or inability to get an erection
- Poor blood supply to your legs, your kidneys, or other organs
- Spinal cord injury
- Wound breaks open
- Wound infections
Before the Procedure
Your will have a physical exam and get tests before you have surgery.
Always tell your provider what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.
If you are a smoker, you should stop smoking at least 4 weeks before your surgery. Your provider can help.
During the 2 weeks before your surgery:
You will have visits with your provider to make sure medical problems such as diabetes , high blood pressure , and heart or lung problems are well treated.
- You may be asked to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), clopidogrel (Plavix), naprosyn (Aleve, Naproxen), and other drugs like these.
- Ask which drugs you should still take on the day of your surgery.
- Always tell your provider if you have a cold, flu, fever, herpes breakout, or other illness before your surgery.
DO NOT drink anything after midnight the day before your surgery, including water.
On the day of your surgery:
- Take the drugs you were told to take with a small sip of water.
- You will be told when to arrive at the hospital.
After the Procedure
Most people stay in the hospital for 5 to 10 days. During a hospital stay, you will:
- Be in the intensive care unit (ICU), where you will be monitored very closely right after surgery. You may need a breathing machine during the first day.
- Have a urinary catheter
- Have a tube that goes through your nose into your stomach to help drain fluids for 1 or 2 days. You will then slowly begin drinking, then eating.
- Receive medicine to keep your blood thin
- Be encouraged to sit on the side of the bed and then walk
- Wear special stockings to prevent blood clots in your legs
- Be asked to use a breathing machine to help clear your lungs
- Receive pain medicine into your veins or into the space that surrounds your spinal cord (epidural)
Outlook (Prognosis)
Full recovery for open surgery to repair an aortic aneurysm may take 2 or 3 months. Most people make a full recovery from this surgery.
Most people who have an aneurysm repaired before it breaks open (ruptures) have a good outlook.
Outlook (Prognosis)
Recovery after endovascular repair is quick in most cases.
You will need to be watched and checked regularly to make sure your repaired aortic aneurysm is not leaking blood.
