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Aortic Aneurysm

 
 

What is it?

The aorta is a big pipe (artery) which carries blood from your heart to your legs. It runs deep in your tummy down to the level of your navel. There it branches into the two arteries which run down to your legs. Sometimes the aorta forms a blow-out like a balloon (an aneurysm). This is dangerous because the aneurysm can leak or burst, causing fatal internal bleeding. Sometimes pieces of the lining of the aneurysm break off and block the leg arteries. The aneurysm needs to be replaced by a new artery.

The Operation

You will have a general anaesthetic and be completely asleep during the operation. A cut is made in the skin of the tummy, usually to the left of the navel, from the ribs down to the groin. A new pipe (artery) , made of a tube of very strong plastic fabric, is used to replace the diseased part of the aorta and is stitched in place inside the aneurysm. It is called a graft. The cut in your tummy is then stitched up. Sometimes the two arteries which run to your legs have aneurysms as well. A new pipe made from the same material as described before, is shaped like a pair of trousers is then used to make the repair. The turnups of the trousers are stitched to the leg arteries. An extra cut in each groin is needed for this type of operation. If one or more arteries are blocked, they may be operated on at the same time. The new pipes last for 20 years and more. The operation takes about three to four hours.

Any Alternatives

If you leave things as they are, there is a high chance of the aneurysm bursting (rupturing). Also, as the aneurysm gets bigger, it becomes more difficult to operate on. Smaller operations do not work. Wrapping the aneurysm to support it, taking out the aneurysm, and filling the aneurysm to prevent it leaking are not as good as grafting the aorta. Tablets and medicines will not be helpful, neither will X-ray and laser treatment. In some very selective cases and only in highly specialised centres it is possible to place the new pipes into the aneurysm via small cuts in one or more of your leg arteries and by using special radiological techniques. This method however, is not widely used. The best way forward for you is to have the planned operation.

Before the operation

You may have come to hospital as an emergency. If not, stop smoking and get your weight down if you are overweight. (See Healthy Living). If you know that you have problems with your blood pressure, your heart, or your lungs, ask your family doctor to check that these are under control. Check the hospital's advice about taking the Pill or hormone replacement therapy (HRT). Check you have a relative or friend who can come with you to the hospital, take you home, and look after you for the first month after the operation. Bring all your tablets and medicines with you to the hospital. On the ward, you may be checked for past illnesses and may have special tests to make sure that you are well prepared and that you can have the operation as safely as possible. Many hospitals now run special preadmission clinics, where you visit for an hour or two, a few weeks or so before the operation for these checks. If you come to the hospital as an emergency, there may not be time to do more than the essential checks. Nevertheless, everything possible will be done to ensure that you will go to theatre for your operation in the safest possible condition.

After - In Hospital

You are unlikely to remember anything for several hours after the operation. You will probably be taken to the Intensive Therapy Unit (ITU) and wake up in a bed there. It is quite likely that you will be connected to an anaesthetic ventilator for a day or two to help you get better. This means that there will be a tube down your mouth passing into your windpipe. The machine will be pumping oxygen in and out for you. You will have sedatives to help you relax if you need them. There will be lots of other tubes and wires connecting part of you to various gadgets. For instance, there will be a tube down the back of your nose to keep your stomach empty. There will be a wound drainage tube in the skin of your tummy. This is to drain any residual blood or other fluid form the area of the operation. There will be a tube in your bladder to collect urine. This may make you feel that you are wanting to pass urine all the time, but it will pass off. You will have one or more fine, thin plastic tubes in the veins of your arms and on the side of your neck to give you liquids. There will be several wires attached to your chest to check your heart action. You will have a cuff on one arm which squeezes automatically every few minutes to measure your blood pressure. As you get better the various tubes are taken out. After a day or two, you will be able to go back to your original surgical ward without any tubing.

The pain of the wounds will be controlled by painkillers. These may be given in several different ways. Until the bowel starts up again, you will be given water, salts, and sugar solutions into your arm vein. Each wound has a dressing which may show some staining with old blood in the first 24 hours. There will be stitches or clips in the skin. You will probably need 14 days or more in hospital before you are strong enough to leave hospital. You will have an appointment to visit the outpatient department for a check up about one month after you leave hospital. Please ask the nurses for sick notes, certificates etc.

After - At Home

You are likely to feel very tired for a month or more. You should be feeling back to normal after about three months. You can drive as soon as you can make an emergency stop without discomfort in the wound, i.e. after about six weeks.

Possible Complications

As with any operation under general anaesthetic there is a risk of complications related to your heart or your lungs. The tests that you will have before the operation will make sure that you can have the operation in the safest possible way and will significantly reduce the risk for such complications. The chances of complications increase significantly when the operation is being done as an emergency for a ruptured aneurysm. Only 50% of patients survive such an emergency operation.

Because of the difficulty of the operation, there is a possibility of bleeding which will require another operation to stop it. There is also a chance of infection. If this is localised in the wound it is usually treatable with antibiotics. If it spreads into your bloodstream or if it involves the new pipes that were used to repair the aneurysm, it is a very difficult and potentially lethal condition.

Sometimes there are problems with the circulation to the legs, feet or toes. This is because of poor blood flow below the area of the repair of the aneurysm. This can be something that can be fixed with a new operation or might result in the need to amputate the area that has the poor blood supply such as the toe or the leg.

There is a chance that your kidneys will be affected by this operation. This happens either because your blood pressure was very low for a long period of time during the operation or because the arteries that connect the aorta with the kidneys and feed the kidneys with blood get partially or completely damaged during the operation. This happens in 6% of patients who have the operation electively (not as an emergency procedure) and in 75% of patients who have an emergency procedure for a ruptured aneurysm. Your kidneys might be affected to the point where you will need dialysis. In this case, a machine removes all the extra fluid and waste products from your body that your kidneys can’t get rid of anymore. In the majority of cases, your kidneys recover relatively soon, but there is chance that they will be permanently damaged and you will need dialysis for the rest of your life.

There is up to a 6% chance that the blood supply to part of your bowel will be affected during the operation. This is a very serious and potentially lethal condition since this part of the bowel can get necrotic (start dying) and an operation will be necessary to remove it.
Another serious complication which happens relatively rarely is paralysis of your legs. This happens because the blood supply to the your spinal cord can be affected during this operation especially if it is done as an emergency.

Sometimes the operation will upset the nerves that control sex in the male. This will be discussed with you.

General Advice

Although the operation is performed routinely in many hospitals it should not be underestimated. These notes should help you through your operation. They are a general guide. They do not cover everything. Also, all hospitals and surgeons vary a little. If you have any queries or problems, please ask the doctors or nurses.

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