Abdominal aortic aneurysm repair - open?

Answer 1

Definition

Open abdominal aortic aneurysm repair is surgery to fix a widened part (or aneurysm) in your aorta, 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.

Your surgeon opens up your belly and replaces the aortic aneurysm with a fabric material.

Alternative Names

AAA - open; Repair - aortic aneurysm - open

Description

The surgery will take place in an operating room. You will be given general anesthesia (asleep and pain free).

• In one approach, you will be lying on your back. The surgeon will make an incision (cut) in the middle of your belly, from just below the breastbone to below the navel. Sometimes the cut goes across the belly.
• In another approach, you will be lying on your right side. The surgeon will make a 5- to 6-inch cut from to the left side of your belly, ending a little below your belly button.
• After finding your aorta, your surgeon will place two clamps on it, one below the aneurysm and one above it.
• The surgeon will cut the aneurysm open. The surgeon will attach a graft, a long tube of a man-made materials (either Dacron or polytetrafluoroethylene), to the sides of the aorta, connecting the parts above the aneurysm and below it. )
• The surgeon will wrap the wall of the aneurysm around the graft. The clamps are removed to allow blood to flow. The surgeon then closes up the incision.

See also: Aortic aneurysm repair - endovascular

Why the Procedure Is Performed

Open surgery to repair an abdominal aortic aneurysm is sometimes done as an emergency when there is any bleeding inside your body from the aneurysm.

You may also have an abdominal aortic aneurysm that is not causing any symptoms or problems. Your doctor may have found out about this problem from special tests called ultrasound or CT scan. There is a risk that this aneurysm may open up (rupture) if you do not have surgery to repair it. But surgery to repair the aneurysm may also be risky.

You and your doctor must decide whether the risk of having this surgery is smaller than the risk of bleeding if you do not have the surgery. The doctor is more likely to recommend surgery if the aneurysm is:

• Larger (about 2 inches)
• Growing more quickly (a little less than 1/4 inch over the last 6 to 12 months)

Risks

The risks for this surgery are higher if you have heart disease, lung disease, kidney failure, or other serious medical problems. Risks or problems or complications are also higher for older people.

Risks for any surgery are:

• Reactions to medicines
• Breathing problems
• Blood clots in the legs that may travel to the lungs
• Heart attack or stroke
• Infection, including in the lungs (pneumonia), urinary tract, and belly

Risks for this surgery are:

• Damage to your intestines or other nearby organs
• Wound infections
• Wound breaks open
• Bleeding before or after surgery
• Poor blood supply to your legs, your kidneys, or other organs
• Spinal cord injury
• Damage to a nerve, causing pain or numbness in the leg

Before the Procedure

Your doctor will do a thorough physical exam and tests before you have surgery.

Always tell your doctor or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.

If you are a smoker, you should stop. Your doctor or nurse can help.

During the 2 weeks before your surgery:

• You will have visits with your doctor to make sure medical problems such as diabetes, high blood pressure, and heart or lung problems are being treated well.
• 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 your doctor which drugs you should still take on the day of your surgery.
• Always let your doctor know about any cold, flu, fever, herpes breakout, or other illness you may have 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 your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you 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.

References

Gloviczki P, Ricotta JJ II. Aneurysmal vascular disease. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 65.

Greenhalgh RM, Powell JT. Endovascular repair of abdominal aortic aneurysm. N Engl J Med. 2008 Jan 31;358(5):494-501.

Lederle FA, Kane RL, MacDonald R, Wilt TJ. Systematic review: repair of unruptured abdominal aortic aneurysm. Ann Intern Med. 2007 May 15;146(10):735-41.

Answer 2

Definition

Open abdominal aortic aneurysm repair is surgery to fix a widened part (aneurysm) in your aorta, 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.

Your surgeon opens up your belly and replaces the aortic aneurysm with a man-made, cloth-like material.

Alternative Names

AAA - open; Repair - aortic aneurysm - open

Description

The surgery will take place in an operating room. You will be given general anesthesia (you will be asleep and pain-free).

• 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 navel. 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 cut from the left side of your belly, ending a little below your belly button.
• Your surgeon will then replace the part of the aorta that has the aneurysm with a long tube graft. This tube graft is made from man-made (synthetic) cloth and is sewn in with sutures.
• In some cases, the ends of the tube graft will be tunneled through each groin and attached to the leg vessels.
• 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 patients recover in the intensive care unit (ICU) after the surgery.

See also: Aortic aneurysm repair - endovascular

Why the Procedure Is Performed

Open surgery to repair an abdominal aortic aneurysm is sometimes done as an emergency procedure when there is any bleeding inside your body from the aneurysm.

You may also have an abdominal aortic aneurysm that is not causing any symptoms or problems. Your doctor may have found out about this problem from tests called ultrasound or CT scan. 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 doctor must decide whether the risk of having this surgery is smaller than the risk of rupture if you do not have the surgery. The doctor is more likely to recommend surgery if the aneurysm is:

• Larger (about 2 inches or 5 cm)
• Growing more quickly (a little less than 1/4 inch 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 doctor will do a thorough physical exam and tests before you have surgery.

Always tell your doctor or nurse 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 doctor or nurse can help.

During the 2 weeks before your surgery:

• You will have visits with your doctor to make sure medical problems such as diabetes, high blood pressure, and heart or lung problems are being treated well.
• 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 your doctor which drugs you should still take on the day of your surgery.
• Always let your doctor know about any cold, flu, fever, herpes breakout, or other illness you may have 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 your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you 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.

References

Gloviczki P, Ricotta JJ II. Aneurysmal vascular disease. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 65.

De Bruin JL, Baas AF, Buth J, Brinssen M, Verhoeven EL, Cuypers PW, et al: DREAM Study Group. Long-term outcome of open or endovascular repair of abdominal aortic aneurysm. N Engl J Med; 2010:362:1881-1889.

United Kingdom EVAR Trial Investigators, Grenhalgh RM, Brown LC, Powell JT, Thompson SG, Epstein D, Sculpher MJ. Endovascular versus open repair of abdominal aortic aneurysm. N Engl J Med; 2010;362:1863-1871.

Reviewed By

Review Date: 11/18/2010

Shabir Bhimji, MD, PhD, Specializing in General Surgery, Cardiothoracic and Vascular Surgery, Midland, TX. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.