V04 Open Abdominal Aortic Aneurysm Repair

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1 V04 Open Abdominal Aortic Aneurysm Repair What is an abdominal aortic aneurysm? The aorta is the main artery that carries blood from your heart to the rest of your body. It can become enlarged (dilated) and this is called an aneurysm. The abdomen is the most common site for an aneurysm to develop. Your surgeon has recommended an aortic aneurysm repair. However, it is your decision to go ahead with the operation or not. This document will give you information about the benefits and risks to help you make an informed decision. If you have any questions that this document does not answer, you should ask your surgeon or any member of the healthcare team. How does an aortic aneurysm happen? The aorta arches through the chest and down into the abdomen. It is the main blood vessel in the abdominal cavity (see figure 1). Abdominal aorta Figure 1 The abdominal aorta An aortic aneurysm is an enlargement of the aorta, usually caused by changes in the structure of the aorta wall (see figure 2). Aneurysm Figure 2 An abdominal aortic aneurysm An aneurysm has developed because of one of the following risk factors - smoking, high blood pressure, age and a family history of aortic aneurysm. Some of these factors also cause heart disease and stroke (loss of brain function resulting from an interruption of the blood supply to the brain). You may not have been aware that you have an aneurysm because it often does not cause any symptoms. However, if the aneurysm gets too big, it can burst (rupture). This usually causes death. Once the aneurysm gets bigger than 5 centimetres in diameter (just over 2 inches), your surgeon will usually recommend an operation to repair it. However, if you have other serious medical problems, your surgeon may decide to wait and only operate when the aneurysm gets even bigger. When your surgeon recommends an operation, the risk of a serious complication of surgery is lower compared to the risk of death from the aneurysm bursting. What are the benefits of surgery? Surgery should prevent you dying from a burst aneurysm. Copyright 2009 V04 Page 1 of 5

2 Are there any alternatives to surgery? You can decide to leave the aneurysm alone, but it could burst causing sudden death. Lifestyle and medication changes may help prevent further damage but will not reverse the damage that is already done. What will happen if I decide not to have the operation? As the aneurysm gets bigger, the wall becomes weaker and the risk of a rupture increases. If the aneurysm does rupture, the chances of surviving are poor. Only 1 in 4 people survive a ruptured aneurysm. What does the operation involve? The healthcare team will carry out a number of checks to make sure you have the operation you came in for. You can help by confirming to your surgeon and the healthcare team your name and the operation you are having. The operation is performed under a general anaesthetic and usually takes between one and seven hours. Your surgeon or anaesthetist may give you antibiotics during the operation to reduce the risk of infection. Some hospitals use keyhole surgery to insert an expanding graft inside the aneurysm. This technique is only suitable for some people and has advantages and disadvantages. Your surgeon has recommended an open operation for you. In the open operation, your surgeon will make a long cut in your abdomen. They will clamp and open your aorta. Your surgeon may need to close small arteries with stitches. They will then sew an artificial graft in place (see figure 3). Occasionally, your surgeon may need to make cuts in either or both of your groins and connect the lower ends of the graft there. At the end of the operation, your surgeon will close the cuts with stitches or clips. Position of graft Figure 3 An artificial graft inserted inside the aorta What should I do about my medication? You should make sure your surgeon knows the medication you are on and follow their advice. You may need to stop taking warfarin, clopidogrel (Plavix) or aspirin before your operation. If you are a diabetic, it is important that your diabetes is controlled around the time of your operation. Follow your surgeon s advice about when to take your medication. If you are on beta-blockers to control your blood pressure, you should continue to take your medication as normal. What can I do to help make the operation a success? Lifestyle changes If you smoke, try to stop smoking now. Stopping smoking several weeks or more before an operation may reduce your chances of getting complications and will improve your long-term health. For help and advice on stopping smoking, go to You have a higher chance of developing complications if you are overweight. For advice on maintaining a healthy weight, go to Copyright 2009 V04 Page 2 of 5

3 Exercise Regular exercise can reduce the risk of heart disease and other medical conditions, improve how your lungs work, boost your immune system, help you to control your weight and improve your mood. Exercise should help to prepare you for the operation, help with your recovery and improve your long-term health. For information on how exercise can help you, go to Before you start exercising, you should ask a member of the healthcare team or your GP for advice. What complications can happen? The healthcare team will try to make your operation as safe as possible. However, complications can happen. Some of these can be serious. You should ask your doctor if there is anything you do not understand. Any numbers which relate to risk are from studies of people who have had this operation. Your doctor may be able to tell you if the risk of a complication is higher or lower for you. The complications fall into three categories. 1 Complications of anaesthesia 2 General complications of any operation 3 Specific complications of this operation 1 Complications of anaesthesia Your anaesthetist will be able to discuss with you the possible complications of having an anaesthetic. 2 General complications of any operation Pain, which happens with every operation. The healthcare team will try to reduce your pain. They will give you medication to control the pain and it is important that you take it as you are told so you can move about and cough freely. Bleeding during or after surgery. This usually needs a blood transfusion and occasionally another operation. Infection of the surgical site (wound). To reduce the risk of infection it is important to keep warm around the time of your operation. Let a member of the healthcare team know if you feel cold. In the week before your operation, you should not shave the area where a cut is likely to be made. After your operation, you should let your surgeon know if you get a temperature, notice pus in your wound, or if your wound becomes red, sore or painful. An infection usually settles with antibiotics but you may occasionally need another operation. Unsightly scarring of the skin. Blood clots in the legs (deep-vein thrombosis), which can occasionally move through the bloodstream to the lungs (pulmonary embolus), making it difficult for you to breathe. The healthcare team will assess your risk. Nurses will encourage you to get out of bed soon after surgery and may give you injections, medication or special stockings to wear. 3 Specific complications of this operation Graft failure due to a blockage (risk: 1 in 200). Infection of the graft (risk: 1 in 100). If this happens, you may develop an abnormal connection between the aorta and the bowel (aorto-enteric fistula). This is life-threatening and is difficult to treat. Having a bath or shower before your operation to wash your abdomen and groins properly can reduce this risk. Weakening at the bypass graft join, which can cause a false aneurysm (risk: 1 in 50). This is a potentially dangerous swelling and may need a further operation to repair. Abdominal pain and bleeding resulting in a narrowed bowel. This is caused by not enough blood supply to the bowel (ischaemic colitis). Occasionally another operation may be needed (risk: 1 in 50). Copyright 2009 V04 Page 3 of 5

4 Blocking of the leg arteries, caused by the abnormal lining of the aneurysm (distal embolism). This can normally be corrected but may need a small operation called an embolectomy. Occasionally this problem cannot be corrected and may lead to amputation of part of a lower limb (risk: 1 in 50). Severe kidney damage (risk: 1 in 50). If this happens, you may need to have dialysis treatment to do the work of your kidneys. Nerve damage and paralysis (risk: 1 in 400). This can happen if the blood supply to the nerves of the spinal cord gets damaged (spinal cord ischaemia). For men, problems having an erection (risk: 7 in 10). This can happen because of damage to arteries and nerves. Death (risk: 1 in 25 for a planned operation, 1 in 2 for an emergency operation to repair a burst aneurysm). How soon will I recover? In hospital After the operation you will be transferred to the intensive care unit or high-dependency unit, where you will be monitored closely. You should be able to go back to the ward after a few days. You should gradually improve over the next few days and your physiotherapist will encourage you to get out of bed and move about. After about one week, you should begin to eat a normal diet and be able to move about. You should be able to go home after about eight to ten days. However, your doctor may recommend that you stay a little longer. If you are worried about anything, in hospital or at home, contact a member of the healthcare team. They should be able to reassure you or identify and treat any complications. Returning to normal activities Your surgeon will tell you when you can return to work depending on the extent of surgery and your type of work. You will usually need about three months off work to recover. Your doctor may tell you not to do any manual work at first and you should avoid heavy lifting for at least six weeks. Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, you should ask a member of the healthcare team or your GP for advice. Do not drive until you are confident about controlling your vehicle and always check with your doctor and insurance company first. The future Most people make a full recovery. It may take up to three months to get back to normal. Summary An abdominal aortic aneurysm is an enlargement of the aorta due to weakness of its wall. Surgery can be life-threatening. However, the risk of a serious complication of surgery is lower compared to the risk of the aneurysm bursting. You need to know about the complications to help you make an informed decision about surgery. Knowing about them will also help to detect and treat any problems early. Further information NHS smoking helpline on and at for advice on maintaining a healthy weight for information on how exercise can help you for support and information you can trust Vascular Society of Great Britain and Ireland at NHS Direct on ( textphone) Copyright 2009 V04 Page 4 of 5

5 Acknowledgements Author: Mr Bruce Braithwaite MChir FRCS Illustrations: LifeART image copyright 2009 Lippincott Williams & Wilkins. All rights reserved. Local information You can get information locally from: You may also find the following links useful Tell us how useful you found this document at This document is intended for information purposes only and should not replace advice that your relevant health professional would give you. V04 Issued December 2009 Expires end of December Copyright 2009 V04 Page 5 of 5