Patient education: Aortic aneurysm repair (The Basics)

Written by the doctors and editors at UpToDate

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What is an aortic aneurysm? —

This is a problem with the aorta. The aorta is the main blood vessel that comes out of the heart. Blood flows through the aorta to the rest of the body. With an aortic aneurysm, part of the aorta balloons out or bulges.

There are 2 types of aortic aneurysm:

●Abdominal aortic aneurysm ("AAA") – This is when the problem is in the "abdominal aorta." This is the part of the aorta in the belly (figure 1).

●Thoracic aortic aneurysm ("TAA") – This is when the problem is in the "thoracic aorta." This is the upper part of the aorta (figure 2).

Some people have an aortic aneurysm that involves both the thoracic and abdominal aorta. This is called a thoracoabdominal aortic aneurysm ("TAAA") (figure 3).

What is an aortic aneurysm repair? —

This is surgery to fix an aneurysm. It is usually recommended for aneurysms that are:

●Causing symptoms, like belly or back pain

●At risk of bursting, even if they are not yet causing symptoms

The doctor will decide if your aneurysm needs to be repaired based on:

●Your symptoms

●The size of the aneurysm

●How quickly the aneurysm is getting bigger

Aneurysm repair can be done with "open" or "endovascular" surgery. Sometimes, doctors do a combination of both. For open surgery, the doctor makes a large cut ("incision") in your skin to fix your aorta. For endovascular surgery, they make a smaller incision, and get to your aorta through your blood vessels.

How do I prepare for aortic aneurysm repair? —

You might need surgery right away after coming to the hospital. Other times, the doctor can schedule your surgery. The doctor or nurse will tell you if you need to do anything special to prepare.

Before the procedure, your doctor will do an exam. They might send you to get tests, such as:

●Lab tests

●Echocardiogram – This uses sound waves to create images of the heart as it beats.

●Ultrasound, CT or MR angiography, or other imaging tests – These create pictures of the inside of the body.

Your doctor will also ask about your "health history." This involves asking about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes prescription and "over-the-counter" medicines, plus any herbal supplements. It helps to write down and bring a list of your medicines, or bring a bag with all your medicines with you.

●Any allergies you have

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

You will also get information about:

●Eating and drinking before the procedure – You might need to "fast" before the procedure. This means not eating or drinking anything for a period of time. Or you might be allowed to have liquids until a short time before the procedure. Whether you need to fast, and for how long, depends on the procedure.

●Lowering the risk of infection – You might need to trim (not shave) your body hair before the procedure. You might also need to wash the area with a special soap.

●What help you will need when you go home – For example, you might need someone else to bring you home or stay with you for some time while you recover.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during aortic aneurysm repair? —

When it is time for the procedure:

●You will get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●You will get anesthesia medicines. This is to make sure you do not feel pain during the procedure. Types of anesthesia include:

•Regional – This blocks pain in 1 area of your body, such as an arm, a leg, or the lower half of your body. You might be awake. Or you might get "sedative" medicines to make you relax and feel sleepy.

•General – This makes you unconscious so you can't feel, see, or hear anything during the procedure. You might get a breathing tube to help you breathe.

●You might get medicines to help control pain after the procedure.

●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure.

●This surgery can be done in 2 ways:

•Open surgery (figure 4 and figure 5) – The doctor will make an incision in your skin. This lets them see directly inside your body to do the surgery.

If the aneurysm is in your belly, the incision will either be in the middle, across, or on the side of your belly. If the aneurysm is in your chest, the incision might be in the center of your chest to cut your breastbone or an incision in the side of your chest. For an aneurysm in the chest and belly, the doctor might make a long incision from the side of your chest down to your lower belly.

The doctor will clamp your aorta above and below the aneurysm. Then, they will replace the bulging part of your aorta with a tube called a "graft." The walls of your aorta cover the graft. They will remove the clamps, and then blood will flow through the graft. If there are problems with other parts of your aorta, its branches, or your heart valves, they can also fix these during open surgery.

In some cases, the doctor will use a "heart-lung machine" to take over the work of your heart during surgery. The machine keeps blood flowing throughout your body. After the doctor repairs the aneurysm, they will take you off the machine.

•Endovascular surgery (figure 4 and figure 6) – The doctor will make a small incision in your skin, and place a thin tube into a large blood vessel in your groin. While this is happening, an X-ray will take pictures of the tube in your body. Once the tube reaches the aneurysm, the doctor will place a "stent graft" into your aorta. Blood flows through the graft, which takes pressure off your aorta.

●The doctor will close your incisions and cover them with clean bandages.

●The procedure often takes 3 to 6 hours. But it can take longer.

What happens after aortic aneurysm repair? —

You will be taken to a recovery room or intensive care unit ("ICU"). The staff will watch you closely as your anesthesia wears off. You will probably stay in the hospital for 1 to 3 days after an endovascular aortic aneurysm repair. If you got open surgery, you will probably stay longer.

As you recover:

●You might feel groggy or confused for a short time. You might also feel nauseous or vomit. The doctor or nurse can give you medicine to help with this.

●If you had a breathing tube, the staff will remove it when you are strong enough to breathe on your own. You might have a sore throat. This usually gets better quickly.

●If you had a tube in your nose or a bladder catheter, the staff will remove it sometime in the next few days.

●The staff will help you get out of bed and start moving around when you are ready.

●You will get medicine to help with pain, if needed. You might also need other medicines or a blood transfusion.

●When you are ready to eat, you will start with clear liquids. Then, you can start eating as you are able. You might feel better if you start with bland foods.

What are the risks of aortic aneurysm repair? —

Your doctor will talk to you about all the possible risks, and answer your questions. Possible risks include:

●Bleeding or blood clots

●Infection

●Damage to organs

●Heart attack, or irregular heart rhythm

●Kidney or lung problems

●Spinal cord injury

●Death

Sometimes, an endovascular stent graft is no longer able to keep pressure off the aorta. If this happens, the doctor will need to do another procedure to fix it.

What else should I know? —

Before you go home from the hospital, make sure you know what problems to look out for and when to call the doctor. Make sure you understand your doctor's or nurse's instructions. Ask questions about anything you do not understand.

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Patient education: Aortic aneurysm repair (The Basics)