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Vascular Center

 

Open AAA Repair

Definition
An aneurysm is a bulge in the wall of a blood vessel. Aneurysms can form in any artery, anywhere in your body, including an artery in your brain. However, most aneurysms occur in the aorta – the bodies largest artery. The aorta carries blood flow from the heart to all vital organs, and eventually to the legs and feet. Aortic aneurysms are caused by a progressive weakening of the aortic wall which results in a “ballooning” of Patient recovering after surgerythe blood vessel. 

Aortic aneurysms are particularly serious because it may burst (rupture), causing internal bleeding that is life threatening. However, when aortic aneurysms are diagnosed early and treated before they rupture, treatment is safe and effective. 

How do I know if I have an aortic aneurysm?

A family history of aortic aneurysm is very concerning so if any of your direct relatives had an aneurysm, tell your doctor so they can arrange a screening exam! The risk of abdominal aortic aneurysm’s increase with age and they are much more common in men than in woman. Aortic aneurysms often enlarge slowly and without signs nor symptoms. This makes them difficult to detect. Often, an aortic aneurysm is discovered incidentally by your doctor through a routine examine of your abdomen for something unrelated like a test to check for gallstones. Aneurysms often start small and stay small. Others expand slowly over time like a tire or balloon that’s slowly being over inflated, increasing in small amounts over an extended period of time. However, larger aneurysms tend to expand at faster rates and are more concerning.

As an aortic aneurysm enlarges, some people may notice:

  • Pulsating mass in the abdomen (stomach)
  • Sudden onset of severe abdominal (stomach) or back pain

Screening and diagnosis
If your doctor suspects an aortic aneurysm specialized testing can confirm it. These tests might include an ultrasound, CT scan, or magnetic resonance imaging (MRI)  scan of your abdomen. These tests can tell us whether an abdominal aortic aneurysm is present and how big it is! These are the key elements to determine the need for treatment!

Why should I have my aneurysm treated?

The primary risk of an abdominal aortic aneurysm is that like a balloon or tire that is blown up too far, it may rupture. A ruptured aortic aneurysm is the 13th leading cause of death in the United States. A ruptured aneurysm is a life threatening emergency resulting in severe internal bleeding. Some famous people have died of this such as Joe DiMaggio, Lucille Ball, Albert Einstein, and John Ritter. 

Aortic aneurysm can also house small blood clots. If a blood clot breaks loose from the wall of the aneurysm and blocks a blood vessel anywhere else in your body, it can cause pain or potentially life-threatening problems. As an example, if a clot breaks loose and blocks blood flow to your leg or foot, it may result in sudden pain, and a cold, numb sensation and loss of strength. If the blood flow isn’t restored quickly, part of your leg or foot may be permanently damaged or even require amputation. 

How is my aneurysm treated?

The primary goal of treatment is to prevent the aneurysm from rupturing. Treatment options depend on the size and location of the aortic aneurysm, how fast it is expanding in size, and your general health. The decision to fix an AAA depends upon a comparison of the risk of rupture versus the risk of the surgery. 

If you have a small aortic abdominal aneurysm – less than 2 inches in diameter – and you have no symptoms, our doctors may suggest a watch-and-wait approach, rather than immediate surgery. If you agree upon this approach, your doctor will need to monitor your aneurysm with ultrasounds every six months and will encourage you to call if you start to experience abdominal tenderness or pain in your abdomen (stomach) or back. However, small aneurysms which cause symptoms (eg-back or abdominal pain) or follow-up studies that reveal rapid growth of the aneurysm may require surgical treatment. 

The risk of rupture increases as the aneurysm enlarges. Once the aortic aneurysm gets larger than 5 centimeters in size the risk of rupture increases dramatically. You will need to discuss the benefits and risks of surgical options with our team of specialists and make a decision together. 

Previously, major surgery was required in the past to repair an aortic aneurysm. Recent advances in endovascular treatment of aneurysms (catheter-based approach) have led to groundbreaking treatments for aortic aneurysms. 

What are my surgical options?

Surgical treatment (Open AAA repair) has been performed routinely for almost 50 years and is a very successful operation. In open surgery, the weakened (ballooned) portion of the aorta is replaced with a man-made graft that is carefully matched to the normal aorta and sewn in place by one of our expert vascular surgeons. This surgery requires a major abdominal incision (12-14 inches long) and the hospital stay averages 6 overnights. Even after an uncomplicated and successful surgery, it often takes 2-3 months before patients can return to a full and normal life. At Maine Medical Center, we have developed a patient teaching brochure and patient picture pathway providing you with a general overview illustrating how your hospitalization course will progress. 

In the days leading up to your operation:

  • You will probably continue to take all major medications; check with your surgeon
  • If not already on a beta-blocker, you will be started on a medication called “Lopressor” (if there is no contra-indication) to decrease the risk of heart related complications
  • The night before surgery do NOT eat anything after midnight. You may have SMALL sips of CLEAR liquids (black coffee, black tea, apple juice, water) up to four hours before your procedure. 
  • You will be given a regime for a bowel prep to clean out your bowels before surgery. 
The day of your operation please:
  • Check in 90 minutes prior to your surgery at the Ambulatory Surgical Unit (next to the emergency room)
  • Leave all valuables and medications at home
    Patient preparing for hospital discharge
    William Pierce preparing for hospital discharge following his ruptured aortic aneurysm repair.
Prior to discharge from the hospital, our team will provide you with detailed discharge instructions including:
  • Activity restrictions
  • Diet
  • Incision or wound care
  • Pain relief
  • When to call your physician for a follow up appointment
  • Who to call with any questions
 
 
 
View information about risk factor modification
 
Health Information

22 Bramhall Street | Portland, Maine 04102-3175 | (207) 662-0111