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Surgical Aneurysm Repair

Introduction

An aneurysm is an abnormal ballooning of the artery which is due to localised area of weakening in the arterial wall. An aneurysm in turn can cause serious complications. It can increase in size and subsequently rupture or it can form a large volume of clot within and block the downhill blood flow to vital organs. Aneurysms can be safely treated by open surgery and keyhole endovascular techniques.

Indication

Aneurysms occur most commonly in the aorta, which is the largest artery in your body running from your heart through the chest and abdomen. Aneurysms that develop in the abdominal and thoracic aorta are referred to as abdominal aortic aneurysm and thoracic aortic aneurysm respectively. These aneurysms have a tendency to grow over a period of time and then there is a risk of rupture (burst). These large aneurysms need surgical repair by either endovascular means or open methods once they reach a certain size threshold where the risk of bursting or rupture becomes high.

Pre-surgical care

At the initial consult, the surgeon will obtain a thorough medical history and perform appropriate physical examination. You will be ordered tests such as a duplex ultrasound and CT scan. Following these investigations, your doctor will be able to discuss the treatment options available. Your doctor will also advice you regarding certain medication which may have to be stopped immediately before the surgery. You will be referred for an anaesthetic assessment in preparation for the surgery.

Surgical procedure

You will be given a general anaesthetic which is often combined with a regional anaesthesia with an epidural to ensure adequate pain relief during and immediately after the surgery. An incision is made in the abdominal wall and after mobilising the bowel, the abdominal aortic aneurysm is exposed. After ensuring satisfactory exposure of the aneurysm both above and below the aneurysm, special instruments are used to clamp the aorta to stop blood flow and prevent blood loss during the surgery. The aneurysm is next opened and after removing all the clots, a graft is stitched in at both ends to normal aorta to allow blood to bypass via the graft. The aneurysmal aortic wall is then closed over the graft after the surgeon is satisfied with the critical aspects of the surgery and after ensuring that there are no leaks. The abdominal wall is finally sutured back and then the skin closed with absorbable sutures or staples.

Post-surgical care

You will be transferred to the intensive care unit after surgery for continuous monitoring initially and then transferred to the ward where you will continue to recover from this major surgery. You may need to stay in the hospital for 7-10 days until your health has improved satisfactorily. You will be advised not to lift anything heavy for 3 months until the surgical wound has healed well.

Risks and complications

The complications of surgical aneurysm repair include:

Breathing problems
Heart problems
Colon problems
Kidney problems

You can improve your lifestyle after surgical aneurysm repair by quitting smoking, having healthy eating habits, exercising regularly and maintaining a normal body weight.