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(Abdominal Aneurysm - Open Repair, AAA Repair, Triple A Repair, Abdominal Aneurysmectomy, Endovascular Aneurysm Repair, EVAR)
Abdominal aortic aneurysm (AAA) repair is a procedure used to treat an aneurysm (abnormal enlargement) of the abdominal aorta. Repair of an abdominal aortic aneurysm may be performed surgically through an open incision or in a minimally-invasive procedure called endovascular aneurysm repair (EVAR).
An abdominal aortic aneurysm, also called AAA or triple A, is a bulging, weakened area in the wall of the aorta (the largest artery in the body) resulting in an abnormal widening or ballooning greater than 50 percent of the normal diameter (width).
The aorta extends upward from the top of the left ventricle of the heart in the chest area (ascending thoracic aorta), then curves like a candy cane (aortic arch) downward through the chest area (descending thoracic aorta) into the abdomen (abdominal aorta). The aorta delivers oxygenated blood pumped from the heart to the rest of the body.
The most common location of arterial aneurysm formation is the abdominal aorta, specifically, the segment of the abdominal aorta below the kidneys. An abdominal aneurysm located below the kidneys is called an infrarenal aneurysm. An aneurysm can be characterized by its location, shape, and cause.
The shape of an aneurysm is described as being fusiform or saccular, which helps to identify a true aneurysm. The more common fusiform-shaped aneurysm bulges or balloons out on all sides of the aorta. A saccular-shaped aneurysm bulges or balloons out only on one side.
A pseudoaneurysm, or false aneurysm, is an enlargement of only the outer layer of the blood vessel wall. A false aneurysm may be the result of a prior surgery or trauma. Sometimes, a tear can occur on the inside layer of the vessel resulting in blood filling in between the layers of the blood vessel wall, creating a pseudoaneurysm.
The aorta is under constant pressure as blood is ejected from the heart. With each heart beat, the walls of the aorta distend (expand) and then recoil (spring back), exerting continual pressure or stress on the already weakened aneurysm wall. Therefore, there is a potential for rupture (bursting) or dissection (separation of the layers of the aortic wall) of the aorta, which may cause life-threatening hemorrhage (uncontrolled bleeding) and, potentially, death. The larger the aneurysm becomes, the greater the risk of rupture.
Because an aneurysm may continue to increase in size, along with progressive weakening of the artery wall, surgical intervention may be needed. Preventing rupture of an aneurysm is one of the goals of therapy.
There are two approaches to abdominal aortic aneurysm repair. The standard surgical procedure for AAA repair is called the open repair. A newer procedure is the endovascular aneurysm repair (EVAR).
The physician will determine which surgical intervention is most appropriate, either open repair or EVAR.
Reasons an abdominal aortic aneurysm repair may be performed include, but are not limited to, the following:
There may be other reasons for your physician to recommend an abdominal aortic aneurysm repair.
As with any surgical procedure, complications can occur. Some possible complications may include, but are not limited to, the following:
Patients who are allergic to or sensitive to medications, contrast dyes, iodine, shellfish, or latex should notify their physician.
There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.
Abdominal aortic aneurysm repair requires a stay in a hospital. Procedures may vary depending on your condition and your physician's practices.
Generally, an abdominal aortic aneurysm repair follows this process:
After the procedure, you may be taken to the recovery room before being taken to the intensive care unit (ICU) to be closely monitored. Alternatively, you may be taken directly to the ICU from the operating room. You will be connected to monitors that will constantly display your electrocardiogram (ECG or EKG) tracing, blood pressure, other pressure readings, breathing rate, and your oxygen level.
You may have a tube in your throat so that breathing can be assisted with a ventilator (breathing machine) until you are stable enough to breathe on your own. As you continue to wake up from the anesthesia and start to breathe on your own, the breathing machine will be adjusted to allow you to take over more of the breathing. When you are awake enough to breathe completely on your own and you are able to cough, the breathing tube will be removed.
After the breathing tube is out, your nurse will assist you to cough and take deep breaths every two hours. This may be uncomfortable due to soreness, but it is extremely important that you do this in order to keep mucus from collecting in your lungs and possibly causing pneumonia. Your nurse will show you how to hug a pillow tightly against your chest while coughing to help ease the discomfort.
You may receive pain medication as needed, either by a nurse, through an epidural catheter, or by administering it yourself through a device connected to your intravenous line.
You may be on special IV medications to help your blood pressure and your heart, and to control any problems with bleeding. As your condition stabilizes, these medications will be gradually decreased and discontinued as your condition allows.
Once the breathing tube has been removed and your condition has stabilized, you may start liquids to drink. Your diet may be gradually advanced to more solid foods as you are able to tolerate them.
If you have a drainage tube in your stomach, you will not be able to drink or eat until the tube is removed. The drainage tube will be removed when your intestinal function has returned to normal, usually two to three days after the procedure.
When your physician determines that you are ready, you will be moved from the ICU to a post-surgical nursing unit. Your recovery will continue to progress. Your activity will be gradually increased as you get out of bed and walk around for longer periods of time. Your diet will be advanced to solid foods as tolerated.
Arrangements will be made for a follow-up visit with your physician.
You may or may not be taken to the intensive care unit (ICU); however, you may be taken to a post anesthesia care unit (PACU). You will be connected to monitors that will constantly display your electrocardiogram (ECG or EKG) tracing, blood pressure, other pressure readings, breathing rate, and your oxygen level.
You will remain in either the ICU or PACU for a designated period of time and then transferred to a regular nursing care unit.
You will be given pain medication for incisional pain or you may have had an epidural (a type of anesthesia that involves continually infusing an anesthetic medication through a thin catheter (hollow tube) into the space that surrounds the spinal cord in the lower back, causing numbness in the lower body, abdomen, and/or chest) placed during surgery which will help with postoperative pain.
Your activity will be gradually increased as you get out of bed and walk around for longer periods of time. Your diet will be advanced to solid foods as tolerated.
Once you are home, it will be important to keep the surgical area clean and dry. Your physician will give you specific bathing instructions. The sutures or surgical staples will be removed during a follow-up office visit, in the event they were not removed before leaving the hospital.
The surgical incision may be tender or sore for several days after an aneurysm repair procedure. Take a pain reliever for soreness as recommended by your physician.
You should not drive until your physician tells you to. Other activity restrictions may apply.
Notify your physician to report any of the following:
Your physician may give you additional or alternate instructions after the procedure, depending on your particular situation.
The content provided here is for informational purposes only, and was not designed to diagnose or treat a health problem or disease, or replace the professional medical advice you receive from your physician. Please consult your physician with any questions or concerns you may have regarding your condition.
This page contains links to other Web sites with information about this procedure and related health conditions. We hope you find these sites helpful, but please remember we do not control or endorse the information presented on these Web sites, nor do these sites endorse the information contained here.
American Heart Association
National Heart, Lung, and Blood Institute (NHLBI)
National Institutes of Health (NIH)
National Library of Medicine
Society for Vascular Surgery - VascularWeb
Society of Interventional Radiology
Society of Thoracic Surgeons
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