Information for patients with a thoracic aortic aneurysm.
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1 Information for patients with a thoracic aortic aneurysm. What is an aortic aneurysm? The aorta is the largest artery in your body, and it delivers blood from your heart and passes through the chest and abdomen. When a weak area of the aorta expands or bulges, it is called an aortic aneurysm. Many people have small aortic aneurysms which cause them no harm. Larger aneurysms are a health risk because they can burst, or rupture. A ruptured aneurysm can cause severe internal bleeding, which is life threatening. Only 1 in 4 patients survive a ruptured aneurysm. When diagnosed early, aortic aneurysms can be treated, or even cured, with highly effective and safe treatments. What symptoms can occur? Most aortic aneurysms cause no symptoms and are diagnosed on a chest X-ray or computerized tomography (CT) scan performed for other reasons. Symptoms may occur due to the aneurysm pressing on nearby organs, or if the aneurysm leads to dissection (splitting of the aortic wall). Symptoms of dissection include severe tearing pain in the chest or back, stroke, cold or numb legs, or abdominal pain. When is treatment needed? Most small aneurysms will not require treatment and your surgeon will arrange monitoring with regular ultrasound or CT scans. If your aneurysm causes symptoms or increases in size then your surgeon will usually advise an operation. What are the benefits of surgery? Surgery will repair the aorta and prevent it from rupturing. Page 1 of 5
2 Are there any alternatives to surgery? You can decide not to have an operation but there will be a risk that your aneurysm will get bigger or rupture. Stopping smoking can slightly decrease the rate of aneurysm growth and rupture. What operation may be needed? There are 2 types of operation. Standard Operation The standard treatment is replacement of the aneurysm with a strong fabric graft. This is performed under general anaesthetic by a chest surgeon (at another hospital). The position of some aneurysms means that a heart-lung by-pass machine may be needed. Most patients spend 2 days in intensive care and a further week in hospital. Full recovery takes around 3 months. If this surgery is recommended then a chest surgeon will discuss it in detail with you. Stent Graft Operation A newer technique called stent grafting involves inserting a reinforced fabric graft through long tubes placed in arteries in the groins. This avoids the need for a chest operation and can be performed under general anaesthetic, epidural or local anaesthetic. The time spent in hospital following this procedure is much less (typically 3 days) and recovery time is also much faster. The risk of complications from this technique may be lower but the long term reliability is still uncertain. Some patients may require further treatments if the stent graft changes position or leaks. How do I prepare for the stent graft operation? Your surgeon will give you more detailed information about the stent graft operation. They will also discuss the risks and benefits of having an operation. You will attend a pre assessment clinic to establish your general health and an anaesthetist will talk to you about your anaesthetic and the operation. Page 2 of 5
3 You may have an ultrasound scan of your abdomen and a CT scan of your chest and abdomen to help plan your treatment. You may have some tests done as an outpatient, or you may be admitted to the hospital for a few days. It is very important that you stop smoking; advice can be given to you at the pre assessment clinic and by your practice nurse What complications can happen with the stent graft operation? Complications can occur following either operation. Some are less serious and may include swelling bruising and infection around the wound site. With a stent graft operation the risk of serious complications including death, stroke or paralysis is approximately 1 in 10. Although worrying, this is much lower than the risks of rupture and is also lower than the risks of the standard operation. Sometimes further treatments are needed if stent grafts develop a leak or move position. You will be asked to have regular scans to detect such problems. If you do not wish to have regular follow up then a standard operation may be a better option. The long term results of stent graft treatment are still uncertain but NICE (National Institute for Health and Clinical Excellence) advises that it is a suitable alternative to traditional surgery for some patients. Your vascular surgeon will discuss the important risks and benefits with you and answer your questions. Page 3 of 5
4 What happens during the stent graft operation? The operation is carried out under a general anaesthetic. Your vascular surgeon will clean your skin and shave hair around both groins to decrease the risk of infection. Your vascular surgeon will then cut into the skin and expose the blood vessels in your groin. An interventional radiologist (doctor with specialist experience in x-ray guided treatments) places a guide wire into your femoral artery and advances it to the aneurysm. You will not feel the wires or catheters as they move through your body. Using x ray guidance a stent is placed across the aneurysm. The graft expands to fit snugly against the walls of your artery. What happens after the operation? You will be carefully monitored in the high dependency unit or intensive care for 24 hours. During this time you will have a bladder catheter and receive fluids from a drip. You may have an oxygen mask to aid your breathing after the anaesthetic. A wound drain is sometimes inserted in the area of the wound dressing. We aim to keep you free from pain and any feeling of sickness, please tell the nurse if you are uncomfortable. You should be able to go home after about 3 days, however your doctor may recommend you stay longer. If you are worried about anything, in hospital or home please talk to a member of staff. How soon will I be back to normal? Be guided by how you feel but expect to be tired for at least 4 to 6 weeks. It will take several weeks to fully regain your strength. Your surgeon will let you know when it is time to return to work. If you drive, you need to be safe whilst in control of your car. You will need to speak to your insurance company about this. To decrease the risk of future problems you should consider changes that will help lower your blood pressure and decrease the chances of further arterial disease. These changes include: Eating foods low in fat, cholesterol and calories Maintaining your ideal body weight Exercise, such as brisk walking, for 20 to 30 minutes at least 5 times per week Stopping smoking. Page 4 of 5
5 Where can I get more information? The vascular nurse can be contacted on Monday to Friday 9-5. There is an answer machine where you can leave a message at other times. If you need advice outside these hours please contact your General Practitioner. Further useful information is available at Revised May 2008 (authors Colin Nice, Maggie Williams, Joanne Coleman, Helen Kendall. Radiology/Vascular surgery,) References Endovascular stent graft placement in thoracic aortic aneurysms and dissections National Institute for Health and Clinical Excellence Issue date: June 2005 Data Protection Any personal information is kept confidential. There may be occasions where your information needs to shared with other care professionals to ensure you receive the best care possible. In order to assist us improve the services available your information may be used for clinical audit, research, teaching and anonymised for National NHS Reviews. Further information is available in the leaflet Disclosure of Confidential Information IL137, via Gateshead Health NHS Foundation Trust website or the PALS Service Information Leaflet: NoIL143 Version: 3 Title: Information for Patients with a Thoracic Aortic Aneurysm First Published: June 2008 Last Reviewed: September 2012 Review Date: September 2014 Author: Dr Colin Nice Radiology This leaflet can be made available in other languages and formats upon request Page 5 of 5
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