Abdominal Aortic Aneurysm Repair
Things You Should Know

Abdominal aortic aneurysm repair is undertaken either as a major open abdominal surgery or as a "minimally invasive" keyhole surgery where a graft is railroaded into the ballooned part of the aorta, through a small pinhead-size cut in the groin. But at what stage does someone require an operation, who and what determines whether you should have an open surgery or minimally invasive surgery, what do you expect in each case, what is recovery like, and when can you go back to work after an abdominal aortic aneurysm repair?

Have you or someone dear to you just found out that you have an aneurysm of the abdominal aorta that perhaps needs repair?

Endovascular Abdominal Aortic Aneurysm Repair

It must have come as a big shock, especially if you just found out unexpectedly after a routine screening.

The good news is that with adequate planning, most aneurysms can be operated upon and repaired successful. There is a very significant reduction of risk of complications and death when surgery is planned.

An undiagnosed ruptured aneurysm without the advantage of careful planning of surgery carries a greater than 90% risk of death. Compare that to a risk of less than 17%, if a planned minimal invasive surgery is undertaken.  

Deciding To Repair An Abdominal Aortic Aneurysm Or Not.

Most cases of abdominal aortic aneurysm are accidental finds, as they often go on without any symptoms. Large aneurysms  more than 5cm in diameter (two inches) could cause upper or central abdominal pain that spreads to the back or to the groin.

  • An abdominal aortic aneurysm  is said to exist if there is a localized widening of a part or parts of the abdominal aorta greater than 2.5cm.
  • Small aneurysm are those with diameter of 3 - 5.4 cm. These do not usually require repair. A yearly scan and review and the use of a type of medication called Statins to slow down the rate of expansion is the usual treatment option
  • Large aneurysms are aneurysms with diameter of 5.5cm or more. They usually require repair.

The decision to operate on an aneurysm is usually taken if:

  • There is a large aneurysm with a diameter bigger than 5cm (from 5.5cm) or
  • You suffer with troubling pain from the aneurysm, even at a smaller size or
  • There is a rapidly expanding aneurysm (usually, and aneurysm expand very slowly, at an annual rate of 2-3mm)
  • There is a sudden rupture, and the sufferer able to get to the operating room in time and in reasonable state.

The single most important factor in deciding whether to undertake an abdominal aortic aneurysm repair or not is the size of the localized abnormal widening or ballooning.

If your aneurysm is more than 2 inches (5cm) in diameter, there is an increased risk of this rupturing causing sudden and profound internal bleeding and death.  The best treatment option at this point is to operate.

When Not To Operate

Even with the presence of a large aneurysm, you can decide not to have an operation. Some people with a ruptured aneurysm are often deemed not suitable for surgery too. The decision not to operate might be appropriate if:

  • The sufferer or patient declines surgery, as long as he or she is fully aware of the consequences of this decision which could include certain death
  • Patient is too frail to undergo surgery due to age, or the existence of other chronic medical conditions or a combination of both
  • Where death is almost certainly imminent and an urgent surgical repair is likely to confer no additional benefit in the opinion of the attending surgeons.

Repair Options: Open Abdominal Or Endovascular?

At the moment, there are only two options by way of choice of surgery to repair an abdominal aortic aneurysm, whether ruptured or not. They are:

1. Open Abdominal Repair

An open abdominal aortic aneurysm repair involves the following:

  • The surgeon would put the patient to sleep after  doing some tests and scans to confirm the diagnosis
  • A cut is made in the midline on the abdomen, typically from just below the breast plate bone down to below the umbilicus
  • The bowels and part of the small intestines are pushed out of the way and a cut is made to the floor of the abdomen to each the diseased part of the aorta
  • A clamp is placed at the top of the  ballooned part of the aorta
  • A quick cut is then made into the ballooned segment of the aorta to open up the lumen of the ballooned aorta
  • A stent or graft (synthetic material that looks like and feels like a normal aorta) is sewn into  the diseased part of the aorta above and below the ballooned segment
  • The clamps are removed and tested to ensure that there is no leakage
  • The opened flaps of the ballooned segment of the aorta are then sewed over the graft
  • The floor of the abdomen is repaired over the now repaired aneurysm
  • The bowels and intestines pushed back to place
  • The muscles and skin over the abdomen are then stitched together and the surgery is over.

The surgery takes about 40 minutes or less in the hands of some very fast vascular surgeons - from the first cut to the last stitch.

After the open abdominal aortic aneurysm repair surgery, you will be taken out of theater into the recovery room, gently allowed to wake up. You will find drips attached to you. There would be a heavy dressing or plaster over your abdomen. As you continue to wake up fully, you may start feeling some pain around the operation site. This is usually mild to moderate in intensity. Your attending anesthetist or nurse can get you some additional pain killers if you want. Do not hesitate to ask for.

You will need to stay in hospital for about 7 to 10 days after an abdominal aortic aneurysm repair.

You will need at least 6 weeks off work after discharge from hospital following an open repair of an abdominal aortic aneurysm. Some people recover quicker and would be fine even before this 6 weeks time frame, while some may need up to 10 weeks.

You can see complications of aortic aneurysm repairs here.

2. Endovascular Repair

This is also referred to as EVAR for short. It is a minimally invasive surgery for the repair of AAA. This means that the repair does not involve a big operation or opening up of the abdomen. Endovascular abdominal aortic aneurysm repair surgery is increasingly used as the treatment of choice for:

  • Healthy seniors in which this condition is found accidentally or during routine screening, as well as for even
  • Frail patients or those with multiple co-existing medical problems
  • Those with a sudden rupture, if deemed suitable by the operating vascular surgeon.

This procedure has a huge advantage over open repair because it helps reduce the risk of death significantly. Up to 5 out of every 100 persons discharged after a successful repair of their aneurysm dies within the first 30 days with an open repair.

This number drops to about 1 in a 100, with EVAR or endovascular repair.

So too is the risk of death during an operation reduced significantly if this minimally invasive technique is used.

Endovascular abdominal aortic aneurysm repair involve the use of a small device to pass a graft into the ballooned part of the aorta through a small cut about the size of a pin head in the groin. The graft is passed through one of the arteries in the upper thigh or groin and allowed to open up and strengthen the weak wall of the ballooned aorta segment.

Abdominal Aortic Aneurysm Repair: Tell Us Your Story!

Have you or your loved one had an abdominal aortic aneurysm repaired? Or is one being planned and you have some queries? Whatever brought you here, we would love to hear from you. Tell us your story. Share your thoughts or questions here!

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Related Pages

You can read more about abdominal aortic aneurysm by going to any of the following pages:

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