What is aortic aneurysm surgery?
Aortic Aneurysm surgery is a procedure to repair a weakened aorta due to the ballooning abnormal bulge of the aorta.
The aorta is the main blood vessel that helps to transport blood from the heart to the remainder of your body.
The walls of the artery are usually thick and strong but could be weakened when blood continuously pushes against them. This leads to swelling.
Certain genetic conditions may also cause bulging of arteries or aneurysms. An aneurysm should be treated as a medical emergency to avoid further growth and possible bursting.
Small aneurysms are treated successfully using medication. If the aneurysm is too large, you will need to undergo surgery.
During such a procedure, your surgeon removes the diseased section of the aorta and inserts a graft in its place.
The graft acts as the new lining for the aorta, permitting the safe passage of blood. A vascular or thoracic surgeon will administer this procedure in a surgical suite.
If the aneurysm is situated in your belly, it is known as an abdominal aortic aneurysm. A thoracic aortic aneurysm is situated in your chest.
Like any other major surgery, aneurysm surgery carries its fair share of risks, including blood clots, stroke, and bleeding. It is nonetheless necessary to avoid further complications such as death.
Discuss with your provider the various medical options available to you to treat aortic aneurysm and whether surgery is necessary. This is determined by the size of the aneurysm, whether you are at risk of rupturing, and where it is located.
Other considerations that your surgeon will need to consider for your choice of treatment include medical history and overall health.
In case aortic aneurysm manifests in the following signs and symptoms, you need surgery:
- Back pain
- Abdominal pain
- Hoarse voice
- Pain in the jaw
- Unusual heartbeat around your abdomen
- Pain around your neck
- Difficulty in breathing
Who can undergo an aortic aneurysm procedure?
If you have a dissected or ruptured aorta, you are suitable for aneurysm surgery. This could save your life.
Individuals with unruptured aneurysms would also benefit from such a procedure because it will reduce the symptoms and prevent them from getting bigger.
Call your healthcare provider immediately in case you exhibit the following symptoms:
- Increased heartbeat
- Sweaty and clammy skin
- Shortness of breath
- Severe back pain that extends to your legs and belly
- Rapid heartbeat
A weakened aneurysm could be due to:
- High blood pressure – Weakened arteries due to high blood pressure predispose you to the formation of an aneurysm. The main causes of high blood pressure are limited physical activity, smoking, obesity, and stress
- Trauma – An injury to the watery walls may also cause aortic aneurysm
- Atherosclerosis – Atherosclerosis is the formation of plaque by cholesterol in the walls of your arteries. The artery walls narrow, predisposing you to an increased risk of clot formation and increased blood pressure.
- Infection – If you have an infection near the aorta, this might spread and weaken the walls of your arteries, resulting in an aneurysm.
Types of aortic aneurysm surgeries
There are two major surgical procedures to correct for a ruptured or weakened aortic
Open chest/abdominal surgery
This is the conventional surgery for repairing a weakened or ruptured aorta. It is a highly invasive procedure that entails having the diseased section of the aorta replaced with an artificial tube called a “graft”.
The surgery is administered under general anesthesia followed by an incision in your chest or belly, based on where the aneurysm is situated.
The surgeon uses clamps to limit blood flow beneath and above the aneurysm. A heart-lung bypass machine assists with breathing and pumping of blood. If there are no complications, the procedure can take about 2 hours.
You will continue recuperating in the ICU for some time and then get transferred to a general ward.
This procedure avoids abdominal repair or open chest surgery to treat your aneurysm. Instead, the surgeon inserts a stent graft (catheter) into your diseased aorta.
The procedure can be administered under general anesthesia though this is not mandatory. The stent graft so inserted offers support to the bulging artery wall.
Before the procedure
Preparing for aneurysm surgery starts with your correct diagnosis of the condition and identification of a suitable healthcare facility to correct this problem.
Your provider will order a battery of tests and physical exams to ascertain that you can withstand this procedure. This also helps to determine the type of surgery most suitable for you.
Such tests are essential in establishing if you have an aneurysm and the risks involved.
- Blood tests: These check for the levels of triglycerides and cholesterol.
- CT scan: to establish the shape and size of your aneurysm. A CT scan also reveals the structure of the aorta along with any abnormalities
- Abdominal ultrasound: This test helps to establish the flow of blood in your abdomen and whether there are any abnormalities
- Angiography: Checks for blockages in blood vessels
If you have a preexisting medical condition such as diabetes or high blood pressure, it requires proper management before surgery to minimize the risk of complications.
If you are on any medication or supplements, let your provider know of this. This also includes any over-the-counter medication that you might be taking.
If your provider advises you to stop taking medication, it is important that you stick to such advice.
Let your provider know of your general well-being. For example, in case of a flu or cold. This is important because it can affect your reaction to the procedure.
If you are a smoker or take alcohol, you will be advised to stop doing it for at least a few weeks before surgery. Most providers will give you the support needed to quit such habits.
Make sure you have fasted between midnight and the time of surgery.
Liaise with your provider to check whether they provide transport arrangements to and from the surgical unit. If not, have your spouse, family member or friend drive you to the hospital.
Before surgery, you will be asked to sign a consent form. Make sure you have read this document in its entirety and understood the contents very well. Do not sign the form before you have understood everything in it.
During the procedure
The surgical team will get you ready for the surgery and ensure you. This will answer all your queries so that you remain comfortable before the procedure.
The anesthetist administers general anesthesia to ensure you remain asleep during the procedure.
- Incision: The location of the incision depends on where the aneurysm is situated. If the aneurysm is located in your chest, the surgeon makes a long incision to it. If the aneurysm is situated in the belly, the surgeon makes a deep cut to your belly
- Clamping: The surgeon restricts the flow of blood to the aorta with the help of clamps. These are attached in the region below and above the aneurysm
- The surgical team connects you to a heart-lung machine to maintain the flow of blood throughout the body even as the medical procedure is ongoing
- Inserting a graft: The surgeon inserts a graft to replace the diseased part of your aorta. The tube inserted acts as a new lining for the bulging aorta. Once the surgeon stitches the tube in place it acts as a strong support system for blood flow
- Closing: The surgeon uses staples or stitches to close up the incision site on your belly or chest
Aneurysm surgery takes between 2 and 4 hours barring any complications. Once the surgeon has closed, the incision site and restarted your heart, you will be moved to the intensive care unit (ICU).
The surgical team will watch you closely for a few days. The care team monitors your vital signs throughout your stay in the ICU. The surgical team will check for any complications that might arise.
Your recovery will continue in the general ward for the next 1-2 weeks. When you regain consciousness, you are likely to find tubes attached to your stomach and nose to assist with the draining of fluids.
A urinary catheter also helps with draining of urine without you having to go to the toilet
Your surgeon may recommend blood-thinning medication.
He/she may also recommend compression socks to avoid blood clots around the legs. You may feel pain around the site of the incision. You will be prescribed pain medication for this.
The care team will encourage you to move around as part of your recovery. Take as much rest as you need and avoid over-asserting yourself as this can delay your recovery.
Before getting discharged from the hospital, make sure there is someone to drive you home.
Benefits of aortic aneurysm surgery
An aortic aneurysm procedure prevents dissection or rupturing of an aneurysm and is life-saving. For people who have undergone endovascular aneurysm repair, the benefits include:
- Reduced scarring and blood loss
- The recovery period is shorter
- Reduced mortality rate
Although aneurysm surgery may save your life, it carries several risks and complications. Examples of risks and complications include:
- Problem with breathing
- Infection: This includes an infected belly, lungs, graft, or urinary tract
- Organ damage (for example, intestines)
- Stroke or heart attack
- Blood clots
- Injury to the spinal cord
The risk for aneurysm surgery is higher in case the aneurysm is ruptured. Performing surgery before a rapture is better because it comes with a higher chance of survival.
If you have the following conditions, the risk for open surgery increases:
- Heart condition
- Previous stroke
- Kidney failure
The risk for complications after aneurysm surgery increases with advancement in age.
Explore all the likely risks and complications of aneurysm surgery with your provider.
Ask which risks you may be more predisposed to, considering the location of your aneurysm and overall health.
Even with such risks, your surgical team remains committed to ensuring safe and successful surgery.
Recovery after aneurysm surgery
Recovery after aneurysm surgery varies from one person to another. It depends on:
- Type of surgery
- Location of aneurysm
- Previous medical history
You require four to six weeks to make a full recovery. For other people can take up to three months.
During recovery, your healthcare team will restrict you from engaging in the following as it can hinder healing:
Do not drive for at least a week after surgery or until you are no longer taking pain medication.
Avoid baths if your incision has not healed. Avoid engaging in strenuous physical activities such as lifting weights for at least four weeks.
Take the right dose of medication to manage pain from aneurysm surgery as prescribed by your provider. Take such medication at the prescribed time.
Take special care of your incisions as they heal. Follow all the instructions from your provider on changing the dressing and taking a bath.
If you feel like coughing or sneezing, hug a pillow against the site of the wound to alleviate the pain.
Your appetite might change during recovery and this will also affect energy levels. You are also likely to lose weight during the recovery period.
Take a balanced diet with lots of fruits and vegetables to improve wound healing and avoid straining while having a bowel movement. Reduce your sugar and salt intake. Stay hydrated and drink water.
The following lifestyle changes will also improve healing after aneurysm surgery:
- Exercise: Liaise with your provider to identify the most suitable physical activity for you
- Managing preexisting conditions: If you have diabetes, hypertension, or high cholesterol, ensure you take all your medication as prescribed. Check with your provider on what you can do to keep the number low
- Smoking: You need to quit if you are a smoker. This is because tobacco damages your arteries and may result in health complications. Your provider will give you all the support and resources required to quit smoking successfully
Emergency after aneurysm surgery
If you notice any of the following problems while recuperating at home, call your provider immediately:
- In case the incision site is swollen, has drainage or the edges are falling apart
- Shortness of breath
- Swollen legs
- Extreme fatigue
- Continuous belly or back pain
- Blood-stained stool
Cost of aneurysm surgery in India
The cost of aneurysm surgery in India varies based on its location. The cost is cheaper compared to other countries offering the same level of medical care.
Below is a breakdown of aortic aneurysm surgery in selected metropolitan cities across India:
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