A B C D E F G H I J K L M N O P R S T U V W

AORTIC ANEURYSM SURGERY

What is Aortic Aneurysm Surgery ?

The aorta is the largest artery in the body and its branches supply blood to almost every part of the body. In some people, the aorta may become distended with increasing age, either at a single point or at several points. The resulting widening of the aorta is called an aneurysm. This occurs in 5% of men and 2% of women over age 65. Some families seem especially prone to developing them and they are also more common in cigarette smokers and in people with atherosclerosis (hardening of the arteries). If the aorta continues to swell, it can eventually rupture leading to sudden and severe internal bleeding. Most aneurysms are discovered incidentally either during a routine examination by a doctor or if abdominal x-rays or ultrasound tests are performed for some other reason. Pain and tenderness in the region of the aneurysm suggests that it is expanding and that rupture is more likely. Unfortunately, many aortic aneurysms are not detected before they burst. This has led to research into the value of routine screening for this condition, If the rupture is very severe there will be little chance of getting to hospital in time. However, some patients will complain of sudden pain and feeling unwell and will require emergency surgery for an aneurysm that is just about to rupture. Because of the emergency nature of this surgery the results are less satisfactory than if it were being done routinely.

Why is Aortic Aneurysm Surgery being performed ?

Aortic aneurysms give rise to two main problems. Firstly, they may continue to increase in size and eventually rupture. Secondly, pieces of clot can gather within the aneurysm. If they break off, they usually block one of the smaller blood vessels. This may mean that blood supply to a particular organ or limb may be decreased, resulting in pain and even tissue loss or gangrene.

Preparations needed for Aortic Aneurysm Surgery

As surgery for aortic aneurysms is of a major nature, you will need to have a number of tests. This will include scans to check blood flow in the major blood vessels and an assessment of the circulation in the legs. It will also be necessary to assess your heart and lungs in some detail and to check kidney and liver function. This will be done with x-rays, blood tests and possibly with some sophisticated ultrasonic scans. If any significant abnormalities are detected they will be corrected before surgery is undertaken. This may mean that doctors from other specialties will see you and advise on treatment. Most patients having this form of surgery will require admission to the intensive care unit for their immediate post-operative treatment.

What Happens during Aortic Aneurysm Surgery

There are a number of ways of surgically treating aneurysms. The most common involves a long incision in your abdomen. The aorta is clamped just above and below the aneurysm and the area of swollen aorta is then replaced with a synthetic graft. The graft is made of knitted fabric and will not perish. It is sewn into the aorta so that the circulation can be restored. This procedure requires a lengthy general anaesthetic and it is possible that mechanical ventilation (a breathing machine ) may be required for a while after surgery. This usually demands a stay in an intensive care unit. Although this form of surgery is very successful, such a large incision does have its complications. Because of this two further techniques have been developed, involving what is termed « minimally invasive surgery ». The first is called Endovascular Stenting. Under general anaesthetic, an incision is made into the groin and into the femoral artery (which takes blood from the aorta to the leg). An expandable tube (called a stent) is then passed through the artery, back into the aorta where the aneurysm is. The stent is then expanded open, and blood flows through it, as it would do through the graft mentioned earlier. The success rate of this procedure is still under review. The second new technique is also minimally invasive, and involves a keyhole surgery approach through a laparoscope inserted through the abdominal wall. Through this small incision, the aneurysm is dissected out with special instruments. This means that a second , but quite small incision is all that is then necessary to actually sew in the graft. Both these newer procedures have drawbacks, but these approaches are likely to gain favour.

Possible Complications with Aortic Aneurysm Surgery

The major complications related to this procedure are mostly connected with the heart, the lungs and the circulation. Because you are likely to be elderly, you will be more likely to have heart disease already present: so a heart attack is a possibility. Chest infections and kidney failure are two other complications which require intensive management. It is because of the possibility of such complications that you will need to be carefully assessed before surgery and managed very carefully afterwards. With modern surgical practice, there is every chance that you will make a full recovery, despite the apparent hazards.

After Aortic Aneurysm Surgery

You will spend the first few days following aortic aneurysm surgery in intensive care and it is quite likely that you will remember very little of this. As progress is made, breathing assistance and intravenous lines (drips) will be removed. It will be several days before you will be allowed to eat and drink, and normal bowel function returns. Around this time it should be possible to start walking so that in an uncomplicated procedure you should be ready for discharge after 7 to10 days. Follow-up visits will be arranged at the hospital and full mobility should be possible after 3 to 4 weeks. However, it is not unusual for recovery to be a little slower particularly when the surgery is done as an emergency.

If Aortic Aneurysm Surgery is not performed

As aneurysms expand, they are more likely to burst. Once the aorta reaches a little over twice its normal size (around 5.5cm), there is a one in three chance that it will burst within a 5 year period. The results of routine surgery for aortic aneurysms are much better than for ruptured aneurysms. This is why surgeons will recommend surgery once the aneurysm has reached a critical size. If an aneurysm of less than 5.5cm diameter is identified, it is common practice simply to repeat the ultrasound tests at regular intervals. An increase of 1cm within a year, or a measured diameter of 5.5cm Iis sometimes used as a guide as to when surgery should be performed.