AAA - Open Repair of abdominal aortic aneurysm

What is abdominal aortic aneurysm (AAA)?

You should read the information page on AAA - surveillance programme which explains why AAA occurs and how this condition is monitored.

If it has been recommended to you that your AAA should be treated with a surgical procedure, there are two surgical techniques that may be used. The choice between endovascular repair ("EVAR" - EndoVascular Aortic aneurysm Repair, a "keyhole" or minimally invasive technique) and conventional Open surgical Repair ("OR") surgery depends on a number of technical and patient factors and your Vascular Surgeon will advise which is most suitable in your case. There is a separate information page for those who are undergoing EVAR.  

What tests will I need?

The diagnosis is usually made using an ultrasound scan performed in the vascular laboratory or the XRay department. If the decision has been made that you should be assessed for suitability for an operation you will be admitted to hospital. You will admitted by a doctor who will take your history and examine you - during your admission, this process may be repeated many times, this is for your safety. Routine blood tests will be taken. Your regular medication may need to be changed. We usually administer daily heparin injections to prevent leg clots (DVT).

You will usually have an ultrasound scan and often a CT scan (specialised XRay). Your heart will be assessed using an ECG and you may require specialised tests such as an echocardiograph (a special ultrasound scan). Rarely, if your doctor is concerned about the risk of heart disease, a stress test (walking on a treadmill) or a coronary angiogram.

Your breathing will be assessed using a chest XRay, spirometry (or pulmonary function tests)  and/or special blood tests.

Your kidney function will be assessed using special blood tests.

When your tests have been completed. one of the surgical team will discuss your options with you and discuss the surgical procedure. You will have an opportunity to ask any questions at this time and it is useful if you can arrange to have a family member present or for them to meet the surgical team at another time. You will seen and assessed by an anesthetist who will explain your anaesthetic to you

Open Surgical aneurysm repair

You must fast (nothing to eat or drink) from midnight on the night before your operation. If you are not already in hospital, you may be asked to attend on the morning of your planned surgery ("Day of Surgery Admission"). You can read about this and other information about the Operating Theatres in Tallaght University Hospital on the TUH website.

On the morning of surgery, we will confirm that a bed is available in the intensive care unit or the Post Anaesthetic Care Unit, if required, and you will be brought to the operating theatre.

The procedure is usually performed under general anaesthetic. Your anaesthetist may also recommend that you have an epidural anaesthestic also.

When you have been anaesthetised, your surgeon will make an incision in your abdomen and replace the weakened part of your aorta with a tube-like replacement called an aortic graft. This graft is made of strong man-made material, such as plastic, in the size and shape of the healthy aorta. The strong tube takes the place of the weakened section in your aorta and allows your blood to pass easily through it.

After surgery

After the operation you will go to the intensive care unit for one to two days. there will be tubes in your arm veins and arteries and a tube in your nose and bladder but these will be removed over the next few days as you recover. You will sit out on a chair on the first day after your operation and slowly build up your mobility over the next few days. A physiotherapist will help you keep your chest clear and ensure that you are coughing effectively.

Most people are ready for discharge in 7 - 10 days but you might prefer to go to a nursing home for a further two weeks convalescence. We can help you arrange this but this shoudl be planned before your surgery; convalescent beds are not always available. 

After discharge

Poor appetite, lack of energy and disturbed sleep are common and will resolve over weeks or months. You may begin walking straight away but heavier activity should be introduced gradually after 4 to 6 weeks. You will be back to normal by three months.

Complications

While every effort is made to avoid problems, serious complications occur in up to 15% of people having aneurysm surgery. These include:

  • breathing problems (pneumonia)
  • heart problems (heart attack or irregular heartbeat)
  • kidney problems (kidney failure requiring dialysis).

If these problems occur, they may be life-threatening and the risk of death following aneurysm repair is between 5 and 10%. Serious bleeding during or after surgery, wounds problems or deep venous clots are uncommon but do occur.

Further information

Society for Vascular Surgery information for patients (https://vascular.org/patient-resources/vascular-conditions/abdominal-aortic-aneurysm)