Abdominal Aortic Aneurysm (AAA) open repair operation

What is an Abdominal Aortic Aneurysm? 

 Arteries (e.g. aorta) carry blood away from the heart, around the body

 Sometimes arterial walls can weaken

 When blood flows through weakened arterial walls, the high pressure stretches the walls, forming a balloon shape (aneurysm) 🎈

What is an AAA Open Repair?

 Surgery is required when the aneurysm is so big that there is a significant risk it will burst 🏨

 Abdomen is usually cut, or sometimes, a smaller cut in the groin can be made 🏨

 The aneurysm is replaced with an artificial artery (simple tube or branching graft) 

 Endovascular aneurysm repair (EVAR) ('keyhole' surgery, however it is less durable than an AAA open repair) 

 Graft works well for the rest of your life in most cases 🏨

Risks: 

 Deep vein thrombosis/ Pulmonary embolism 

 Graft infection (1 in 500) 

 Chest infection 

 Wound infection 

 Loss of circulation in legs/bowel 

 Bowel slow to start again following surgery 🏨

 Fluid (lymph) leaking from wound 💧

 Impotence  

 National risk of death: 4.3% 

Pre-operative tests: 

 Chest x-ray 

 CT scan (shows aneurysm) 

 ECG (electrocardiogram) 

 Echocardiogram 

 Blood tests 

 Breathing test 

Preparation: 

 Medication: review information you have been given regarding your regular medications 💊

 Fast: according to your instructions 🌭

 Sign: consent form ✍ 

Procedure: 

1. You will be given general anaesthetic 
2. Surgeon will cut across or down the stomach 
3. Enlarged section of aorta is replaced by graft 
4. Aneurysm is closed over the graft 
5. Wound is stitched closed 

Post-operation: 

 First night: spent in overnight intensive recovery (OIR) 🌙

 Morning after: surgeon and anaesthetist decide whether you will be transferred to intensive car high dependency unit (HDU) or to vascular bay 🌥

 May require blood transfusion 

 Discharge: Usually go home 8 to 10 days post-op 

 Physiotherapy: everyday post-op 

 Deep breathing practise 

 Food and drink: gradually reintroduced 🌭

When you get home: 

 Regular exercise: e.g. short walks for first few weeks 🚶

 Driving: usually 3 to 4 weeks post-op (must be able to perform emergency stop) 

 Shower: as normal once home 🚿

 Work: return 6 to 12 weeks later 

 Lifting: avoid for 6 weeks 

 Medicine: aspirin and a statin usually given when you go home 💊

Follow up: 

 Aortic vascular nurse specialist will contact you soon after discharge 

 Six-week post-op follow up appointment with surgeon 

Prevention: 

 Stop smoking 

 Regular exercise 🏊

 Blood pressure: get it checked regularly 

 Blood sugar: keep levels controlled if you have diabetes

 Blood cholesterol: reduce it by eating a healthy, balanced diet; doing regular exercise; take any prescribed medication 💊

Summary:

1. An aneurysm is the ballon shape formed when blood flows through weakened arterial walls and stretches them
2. AAA is the surgery required when an aneurysm is so big that there is a risk it will burst
3. You must prepare according to the instructions given to you in advance
4. You will be given general anaesthetic for the procedure
5. The enlarged section of the aorta is replaced by a graft
6. Follow post-operative instructions 
7. There are preventative measures you can take including: stop smoking, exercise regularly, check your blood pressure, blood sugar, and blood cholesterol regularly