Abdominal Aortic Aneurysmectomy and Grafting

What is abdominal aortic aneurysmectomy and grafting?

Abdominal aortic aneurysmectomy and grafting is a procedure to repair or remove an aneurysm in the aorta (the main artery from the heart to the body). An aneurysm is a weak spot that balloons out from the wall of a blood vessel. Aneurysms can burst and cause internal bleeding. If this happens, you may need emergency surgery to save your life.

A graft is a tube made of Dacron (polyester). It can either brace the weak spot (aneurysm) or divert blood flow around it. This removes the danger of rupture.

Examples of alternatives to this surgery are:

• measures to control high blood pressure
• endovascular grafting (using a catheter to put in the graft instead of surgery).

Your doctor can explain which treatment is best for you.

How do I prepare for this procedure?

Plan for your care and recovery after the operation. Allow for time to rest and try to find other people to help you with your day-to-day duties.

If you need a minor pain reliever in the week before surgery, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This helps avoid extra bleeding during surgery. If you are taking daily aspirin for a medical condition, ask your provider if you need to stop taking it before your surgery.

Follow any instructions your doctor may give you. Take a shower and wash your hair the night before surgery. Eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight and the morning before the procedure. Do not even drink coffee, tea, or water.

Follow your provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For this reason, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery. Also, your wounds will heal much better if you do not smoke after the surgery.

What happens during the procedure?

You will be given a general anesthetic. It will relax your muscles and put you in a deep sleep. It will prevent you from feeling pain during the operation.

During surgery, the abdomen is cut open to expose the aneurysm. The doctor clamps the aorta above and below the aneurysm to stop the flow of blood. The doctor cuts the aneurysm open and removes the material in it. Then a graft is sewn onto the artery above and below the aneurysm. The wall of the aneurysm is wrapped around the graft.

If the aorta is completely blocked, the doctor will use the graft to bypass (go around) the blocked part.

The doctor will then close the incision in your abdomen.

What happens after the procedure?

You will stay in an intensive care unit until your condition is stable, then move to a regular room. Your stay in the hospital may last 1 to 7 days, depending on your condition.

A tube may be inserted down your nose into your stomach to help release fluid and air from the gastrointestinal tract. This tube may remain in place for 2 to 3 days while the intestines recover from the operation.

You should avoid all strenuous activity for 4 to 6 weeks. You should ask your doctor how active you can be and when you should come back for a checkup.

What are the benefits of this procedure?

There is no longer a risk that the aneurysm will burst.

If you had a narrowing of the blood vessels associated with the aneurysm, it may be easier for you to walk, and your blood pressure may improve.

What are the risks associated with this procedure?

• There are some risks when you have general anesthesia. Discuss these risks with your doctor.
• Risk of a heart attack during the operation increases if there is plaque (fatty buildup) in the blood vessels to the heart.
• The kidneys may be damaged if their blood supply is cut off for too long during the operation.
• If removing the aneurysm affects nearby nerves you may have problems with paralysis or sexual performance.
• A piece of blood clot may break off and cause a blockage further down the leg, which may make further surgery necessary.
• You may develop an infection or bleeding.

You should ask your doctor how these risks apply to you.

When should I call the doctor?

Call the doctor immediately if:

• You have a bloated abdomen.
• You become nauseated and start to vomit.
• You develop a fever.
• You develop redness, swelling, pain, or drainage from your incision.
• You become short of breath.
• You have chest pain.

Call the doctor during office hours if:

• You have questions about the procedure or its results.
• You want to make another appointment.