Aortic Aneurysmectomy and Grafting

What is an aortic aneurysmectomy and grafting?

Aortic aneurysmectomy and grafting is a procedure to repair or remove an aneurysm in the aorta. The aorta is the main artery from the heart to the body. An aneurysm is a weak spot that balloons out from the wall of a blood vessel. Aneurysms can burst (rupture) and cause internal bleeding. When an aneurysm bursts, you may need emergency surgery to save your life.

When is this procedure done?

This operation may be done to stop an aneurysm in the aorta from bursting. It may also be done to remove a ruptured aneurysm and repair the aorta.

If you have an aneurysm that has not ruptured, examples of alternatives to this surgery are:

• treatment to control high blood pressure
• endovascular grafting (using a catheter to put in the graft instead of surgery).

Your healthcare provider can explain which treatment is best for you.

How do I prepare for this procedure?

Plan for your care and recovery after the operation. Allow for time to rest and try to find other people to help you with your day-to-day duties.

If you need a minor pain reliever in the week before surgery, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This helps avoid extra bleeding during surgery. If you are taking daily aspirin for a medical condition, ask your provider if you need to stop taking it before your surgery.

Follow any instructions your healthcare provider may give you. Take a shower and wash your hair the night before surgery. Eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight and the morning before the procedure. Do not even drink coffee, tea, or water.

Follow your provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For these reasons, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery.

What happens during the procedure?

You will be given a general anesthetic. It will relax your muscles and put you in a deep sleep. It will prevent you from feeling pain during the operation.

Depending on where the aneurysm is, the surgeon will make a cut (incision) in the abdomen or chest to get access to the aorta. He or she will clamp the aorta above and below the aneurysm to stop the flow of blood. The surgeon will then cut open the aneurysm and remove any material in it. Then a graft is sewn into the artery. The graft is a tube made of Dacron (polyester). The wall of the aneurysm may be wrapped around the graft so that the graft braces the weak spot (aneurysm). If the aorta is completely blocked, the surgeon will use the graft to bypass (go around) the blocked part. The graft removes the danger of rupture or repairs the damage aorta after a rupture. The healthcare provider will then close the cut in your abdomen or chest.

What happens after the procedure?

You will stay in an intensive care unit until your condition is stable and then move to a regular room at the hospital. Your stay in the hospital may last 1 to 7 days, depending on your condition.

A tube may be inserted down your nose into your stomach to help release fluid and air from the gastrointestinal tract. The tube may stay in place for 2 to 3 days while your digestive system recovers from the operation.

You should avoid all strenuous activity for 4 to 6 weeks. Ask your healthcare provider how active you can be and when you should come back for a checkup.

What are the benefits of this procedure?

After this procedure there is no longer a risk that the aneurysm will burst.

If you had a narrowing of the blood vessels in the area of the aneurysm, the repair of the aorta may make it easier for you to walk, and your blood pressure may get better.

What are the risks associated with this procedure?

• There are some risks when you have general anesthesia. Discuss these risks with your healthcare provider.
• Risk of a heart attack during the operation increases if there is plaque (fatty buildup) in the blood vessels to the heart.
• The kidneys may be damaged if their blood supply is cut off for too long during the operation.
• If removing the aneurysm affects nearby nerves, you may have problems with paralysis or sexual performance.
• A piece of blood clot may break off and cause a blockage further down the leg, and you may need more surgery.
• You may have an infection or bleeding.

You should ask your healthcare provider how these risks apply to you.

When should I call the healthcare provider?

After the surgery, call your provider right away if:

• You have a bloated (swollen) abdomen.
• You become nauseated and start to vomit.
• You develop a fever.
• You develop redness, swelling, pain, or drainage from your incision.
• You become short of breath.
• You have chest pain.

Call during office hours if:

• You have questions about the procedure or its results.
• You want to make another appointment.