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Abdominal Aortic Aneurysm Repair (AAA)

Posted July 1, 2008 7:40 PM
Posted in

(AAA)

by Editorial Staff and Contributors


Definition

The aorta is the largest artery in the body. The abdominal aorta is the portion of the aorta that carries blood to the abdomen, pelvis, and legs. Sometimes the walls of the aorta weaken and bulge in one area. This creates an abdominal aortic aneurysm (AAA). AAA's are most often a result of atherosclerosis (hardening of arteries) combined with high blood pressure. Surgery is necessary when the AAA becomes large or ruptures.

Abdominal Aortic Aneurysm

Abdominal aortic aneurysm

© 2008 Nucleus Medical Art, Inc.


Parts of the Body Involved

  • Torso
  • Abdominal area

Reasons for Procedure

Surgery to repair an AAA is done when:

  • Aneurysm causes physical symptoms, such as abdominal pain
  • Aneurysm has reached a size of five centimeters across, or has been growing steadily by one or more centimeters for 6-12 months
    • Aneurysms that are less than five centimeters are monitored closely, but are usually not surgically repaired
  • Aneurysm has ruptured
    • Surgery must be done immediately or the rupture can be fatal
    • Symptoms of rupture include sudden, excruciating pain in the back or lower abdomen, and low blood pressure, sometimes leading to shock


Risk Factors for Complications During the Procedure

  • Emergency surgery due to a burst aneurysm
  • Severe hemorrhage
  • Low blood pressure
  • Shock
  • Cardiovascular disease, including angina or a previous heart attack
  • Cerebrovascular disease, including previous episodes of transient ischemic attacks
  • Pre-existing lung disease
  • Debilitation due to cancer
  • Diabetes
  • Obesity

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 or all of the following:

  • CT scan—a type of x-ray that uses a computer to make pictures of structures inside the abdomen
  • MRI scan—a test that uses magnetic waves to make pictures of structures inside the abdomen
  • Abdominal ultrasound
  • Electrocardiogram (ECG, EKG)—a test that records the heart's activity by measuring electrical currents through the heart muscle
  • Chest x-ray

On the day of the surgery, you will be given an antibiotic intravenously (in the vein). You may also be given a laxative or enema to clear the colon.

Anesthesia

General anesthesia

Description of the Procedure

An incision is made from the breastbone to below the belly button. The doctor clamps the aorta slightly above and below the aneurysm. The blood clot on the inside is removed. The aneurysm is removed. An artificial graft made of Dacron is stitched to the normal aorta on either side of where the aneurysm had been. Then the clamps are removed. The wound is closed with stitches.

Abdominal Aortic Aneurysm Surgery

AAA repair

An artificial graft is stitched to the aorta.

© 2008 Nucleus Medical Art, Inc.

After Procedure

You will be sent to the intensive care unit for monitoring. You will have catheters in place, including the following:

  • 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

How Long Will It Take?

4-6 hours

Will It Hurt?

Anesthesia prevents pain during the procedure.

Possible Complications

There is risk with any surgery. Infection, bleeding, or problems from general anesthesia can occur.

  • Excessive bleeding
  • Injury to the ureters
  • Kidney failure
  • Decreased blood supply to the spinal cord
  • Death

Average Hospital Stay

This varies and will be determined by your doctor.

Postoperative Care

After surgery, you may gradually return to normal activities. You will need to manage any risk factors or conditions to prevent further problems. Atherosclerosis and high blood pressure should be managed with medications and a healthful lifestyle.


Outcome

Preventive AAA surgery generally has a good outcome for people who are relatively healthy. Emergency surgery to fix an AAA rupture has a 50% survival rate, due to the rapid loss of blood.


Call Your Doctor If Any of the Following Occurs

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge at the incision site
  • Cough, shortness of breath, chest pain, or severe nausea or vomiting
  • Pain, burning, urgency or frequency of urination, or persistent bleeding in the urine

RESOURCES:

American Heart Association
www.americanheart.org/

National Heart, Lung, and Blood Institute, NIH
http://www.nhlbi.nih.gov/

CANADIAN RESOURCES:

Heart and Stroke Foundation of Canada
http://ww2.heartandstroke.ca/

University of Ottawa Heart Institute
http://www.ottawaheart.ca/

References:

Aneurysm, aortic. American Heart Association Web site. Available at: http://www.americanheart.org. Accessed June 3, 2008.

Medical encyclopedia: abdominal aortic aneurysm. Medline Plus website. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/000162.htm. Accessed June 3, 2008.



Last reviewed November 2007 by J. Peter Oettgen, MD

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.

Copyright © 2007 EBSCO Publishing All rights reserved.

Source: EBSCO
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