Aneurysm surgery

Overview

Aneurysm surgery, also known as traditional open aneurysm surgery, is a crucial treatment for individuals with aortic aneurysms, which pose life-threatening risks by damaging the aorta. The primary objective of open surgery is to avert the potential rupture or dissection of the aneurysm and can also address any damage resulting from such events. During this procedure, a skilled thoracic or vascular surgeon performs a major surgical intervention in a hospital’s surgical suite. To access the aneurysm, a significant incision is made either in the chest for thoracic aortic aneurysms or slightly lower down in the abdomen for abdominal aortic aneurysms. The damaged section of the aorta is excised and replaced with a synthetic fabric tube called a graft, which acts as a new lining for the artery, allowing blood to flow safely.

Aneurysm surgery is often an imperative measure to prevent severe complications or even fatalities. Despite the inherent risks associated with major surgery, the potential benefits generally outweigh these risks. Patients considering this option can expect a thorough discussion of their treatment options with their healthcare provider, who will assess their specific condition and determine whether surgery is the most appropriate course of action.

Reasons for the procedure

Emergency surgery is vital for people with a ruptured or dissected aortic aneurysm – it can save lives. Surgery may also be necessary if you have an aneurysm that might rupture in the future, especially if it’s getting larger or causing symptoms.

If your aneurysm ruptures or dissects, you need surgery immediately. Call emergency services if you experience these symptoms:

• Sweaty, clammy skin
• Feeling dizzy or fainting
• Rapid heartbeat
• Nausea and vomiting
• Difficulty breathing
• Sudden, severe pain in your belly, lower back, or legs
• Sudden, sharp, tearing pain in your chest or back

If you have an aneurysm, it’s crucial to regularly visit your healthcare provider for checkups. Even if the aneurysm hasn’t ruptured, it can still pose a threat. Your provider will monitor it and determine the best treatment plan. You may require surgery if you experience:

• Pain in your abdomen, back, chest, groin, or inner thigh.
• A throbbing sensation in your abdomen.
• Coughing, hoarseness, or difficulty breathing.
• If the aneurysm is larger (at least 5 centimeters in diameter).
• If the aneurysm is growing rapidly (more than 1 centimeter per year).

Your provider will assess the aneurysm’s size, location, and the risk of rupture. They will also consider your overall health and medical history to personalize the treatment to your specific needs. For instance, individuals with Marfan syndrome may require earlier treatment for smaller aneurysms. If you have other health issues that make open surgery risky, your provider may suggest a less invasive procedure called endovascular aneurysm repair (EVAR).

Risk

Surgery to treat an aneurysm can be a life-saving procedure, but it’s crucial to be aware of potential complications and risks associated with it. Some of these risks include:

• Infection
• Bleeding
• Blood clots
• Nerve damage
• Difficulty in breathing
• Damage to intestines or other organs
• Heart attack or stroke
• Kidney failure
• Spinal cord injury

It’s essential to have an open discussion with your healthcare provider about these potential risks, taking into consideration your specific health situation. Remember that every surgical procedure carries some level of risk, but healthcare providers are dedicated to making surgery as safe and effective as possible.

Procedure

This procedure is performed by a skilled and experienced surgeon. It is considered a highly serious surgical intervention. To access the aneurysm, the surgeon is required to make a substantial incision in either the abdominal or chest area. The aortic aneurysm can manifest in either the chest, referred to as a thoracic aortic aneurysm, or slightly lower in the abdomen, known as an abdominal aortic aneurysm.

Before the procedure

Preparing for surgery involves several steps that begin weeks before the actual procedure. Your healthcare provider will assess your health and discuss important details with you:

• Medications: Let your provider know about all the medicines you’re taking, whether they’re prescribed or over-the-counter. Some medications may need to be temporarily stopped before surgery, so follow your provider’s advice closely.
• Health conditions: If you have conditions like high blood pressure, your provider will help you manage them before surgery to ensure your safety.
• Current health: If you’re feeling unwell due to a cold, flu, herpes outbreak, or any other illness, inform your provider. Being sick can affect how your body responds to surgery.
• Smoking: Quit smoking at least one month before surgery. Your provider can provide resources to support your efforts.

On the day of your surgery, your provider will give you specific instructions, including:

• Fasting: Do not consume any food or beverages, including water, after midnight on the night before your surgery.
• Medications: Take any prescribed medications as instructed on the morning of your surgery.
• Transportation: Arrange for someone to drive you home from the hospital after your procedure.

During the procedure

Before your aneurysm surgery begins, your dedicated medical team will ensure your comfort. The procedure involves the following steps:

• Incision: Your surgeon will make a lengthy incision in your skin, exposing your chest or abdominal area. The precise location of this incision depends on the aneurysm’s location, which may necessitate an incision on the front or left side of your chest, potentially extending downward to just below your belly button.
• Clamping: To control blood flow, your surgeon will employ clamps to isolate the sections of your aorta both above and below the aneurysm. In some cases, you may be connected to a heart-lung machine to maintain blood circulation to the rest of your body throughout the surgery.
• Graft insertion: The primary objective of the procedure is to insert a graft. Your surgeon will replace the weakened portion of your aorta with a tube known as a graft. This graft serves as a new lining for your artery and is typically constructed from artificial materials such as polyester fabric. It boasts robust walls to support proper blood flow, and your surgeon will secure it in place using sutures.
• Closure: To conclude the surgery, your surgeon will meticulously close the incision in your chest or abdomen, using either stitches or staples.

Typically, aneurysm surgery requires approximately three to four hours to complete.

After the procedure

After your surgery is completed, you will be transferred to the intensive care unit (ICU) for close monitoring. This observation period will typically last several days before you are relocated to a regular hospital room. Your total hospital stay is expected to range from three to ten days.

During your hospitalization, you will receive the following care:

• Placement of a urinary catheter to assist with urination.
• The insertion of a nasogastric tube to drain fluids from your stomach.
• Administration of blood-thinning medications (anticoagulants).
• Wearing compression socks to reduce the risk of blood clots in your legs.
• Utilization of a breathing machine to provide lung support.
• Provision of pain medication to alleviate discomfort during your recovery.

During the post-operative phase following major surgery, it is imperative to acknowledge the gradual nature of regaining mobility and strength. A prudent approach involves strict adherence to your healthcare provider’s directives, refraining from premature exertion, and affording your body the requisite time for recovery.

Outcome

Recovery timeline:

• Hospital stay: You’ll spend 3 to 10 days in the hospital, with some people needing more time.
• Rehabilitation: After leaving the hospital, you might go to a rehab facility to regain strength and independence.
• Full recovery: It typically takes 4 to 6 weeks for most people, but some may need 2-3 months.

Restrictions during recovery:

• Driving: You must refrain from driving until your healthcare provider grants clearance, which usually occurs after 1-2 weeks post-surgery, upon cessation of pain medication.
• Bathing: Avoid submerging your incision until it has completely healed; opt for showers or sponge baths with vigilance.
• Swimming: Swimming is prohibited until the surgical incision is fully healed.
• Heavy lfting: Do not engage in heavy lifting, defined as loads exceeding 10 pounds, for a period of 4-6 weeks, or as directed by your healthcare professional.
• Strenuous activity: Engaging in strenuous exercises or activities that induce breathlessness is discouraged during this phase.

Managing pain:

• You’ll have prescribed pain medication to take at home; follow a schedule and note when you take each dose.
• Your surgical wound needs special care; your doctor will provide instructions. Change the bandage daily, and shower only if your doctor says it’s safe.
• Ease discomfort while sneezing or coughing by hugging a pillow against your incision.

Changes in appetite and energy:

• Expect reduced appetite for a few weeks; it may take time to return to normal.
• Feeling tired is part of the healing process; discuss your concerns with your doctor.
• Weight loss of up to 20 pounds during recovery can occur.

Preparing your home for recovery:

• Set up a comfortable bed and living area on the first floor to minimize fall risks.
• Stock up on food and personal supplies, and consider preparing and freezing meals in advance.
• Store items in easily accessible places.
• Keep your phone and charger within easy reach.
• If you live alone, ask friends, family, or caregiving services for assistance.

Protecting your investment in health:

• Eat a heart-healthy diet by reducing salt, sugar, and saturated fat intake and staying hydrated.
• Ask your doctor about suitable exercises.
• Quit smoking to protect your arteries and overall health; seek support and resources.
• Manage conditions like high blood pressure, high cholesterol, and diabetes by taking prescribed medications and discussing your numbers with your doctor.
• Join a support group to connect with others who’ve been through similar experiences, stay on track with lifestyle changes, and discover new resources and treatments.”