Abdominal Aortic Aneurysm

What is endovascular repair of an abdominal aortic aneurysm?

Endovascular repair is a type of treatment for an abdominal aortic aneurysm, or AAA. An AAA is a bulge in the wall of the large artery below your heart. The large artery is called the aorta. The bulge is caused by a weak section in the artery wall. The bulge is at risk of tearing. During the procedure, the weak section of the aorta is treated to prevent it from tearing.

Your arteries are the blood vessels that deliver oxygen-rich blood and nutrients to the tissues of your body. The aorta is a large artery that leads from your heart down through the inside of your chest and belly (abdomen). The section that goes through the abdomen is called the abdominal aorta. The walls of your aorta are normally thick enough to withstand the force of the blood pressure from the heart. But some health problems can damage the walls of the aorta. This can cause a balloon-like bulge in the wall of the aorta called an aneurysm. In some cases, an aneurysm can start to split or even burst. This can often cause death. An aneurysm may also start to split along the inside of the aorta wall. This is known as aortic dissection. It can also often cause death.

Many factors can damage the walls of your aorta and cause an aortic aneurysm, such as:

• High blood pressure
• Smoking
• Atherosclerosis
• Injury
• Certain infections (such as untreated syphilis)
• Certain genetic conditions (like Marfan syndrome)

Endovascular repair is a minimally invasive procedure. This means it is done with a small incision. It is often done under general anesthesia, so you sleep through the procedure. During the procedure, a surgeon makes an incision through an artery in your groin. A thin, flexible tube (catheter) is threaded up through the artery and to the site of the aortic aneurysm. A stent graft is sent along the catheter to the aneurysm. The stent graft is a tube made of a thin metal mesh (the stent), covered with a thin polyester fabric (the graft). This stent graft is opened inside the aorta and fastened in place. The stent graft stays in place, and blood flows through it. It protects that part of the aorta, and prevents the aneurysm from bursting.

Why might I need endovascular repair of an abdominal aortic aneurysm?

You may need this procedure if your AAA is over 5 cm or getting larger. You may also need this procedure if your AAA is at risk of splitting or bursting.

A small abdominal aortic aneurysm may not need a medical procedure. This is the case if an aneurysm is less than 5 cm and isn’t getting larger in size. Smaller aneurysms are less likely to burst or split. Your doctor will likely closely watch your health and give medications to lower the risk of aneurysm rupture.

Open surgery and endovascular repair are the two main types of surgery to repair an aneurysm. During open surgery, a surgeon makes a large cut in your belly or chest. The doctor then replaces the damaged part of the aorta with a graft.

Endovascular repair uses a much smaller incision than open surgery. Because of this, it has a lower risk of complications. It may benefit older adults who have a higher risk of complications. It can also lead to faster recovery. Not all aneurysms can be treated with endovascular repair. Your doctor will talk with you about the treatment that will work best for you.

What are the risks of endovascular repair of an abdominal aortic aneurysm?

Every procedure has some risks. The risks of this procedure include:

• Heavy bleeding at the insertion site
• Blood that still flows through the aneurysm bulge
• A graft that moves, bends, or comes loose
• Infection
• Heart attack
• Reaction to anesthesia
• Reduced blood flow to the legs, intestines, or kidneys
• Pressure in the abdomen that can damage organs (abdominal compartment syndrome)
• The need to change to open surgery during the procedure

Your risks may vary depending on your age, your overall health, and the size and location of your aneurysm. Talk with your doctor to learn which risks apply to you. Tell him or her about any questions or concerns you have.

How do I prepare for an endovascular repair of an abdominal aortic aneurysm?

Talk with your doctor how to prepare for your surgery. Tell your doctor about all the medications you take. This includes over-the-counter medications such as aspirin. You may need to stop taking some medications ahead of time, such as blood thinners. If you smoke, you’ll need to stop before your surgery. Smoking can delay healing. Talk with your doctor if you need help to stop smoking.

Let the doctor know if you’ve ever had a problem with sedation. Also, tell him or her if you are pregnant or think you might be pregnant.

Do not eat or drink after midnight the night before your surgery. Tell your doctor about any recent changes in your health, such as a fever.

You may need some tests before your procedure, such as:

• Blood tests, to check for anemia and infection
• An electrocardiogram, to check your heart rhythm
• Echocardiography, to look at the size of your aneurysm
• Computed tomography (CT) scan, to create detailed images of your aneurysm
• Angiography, to get more detail about your aneurysm

Your doctor may give you more instructions about how to prepare.

What happens during an endovascular repair of an abdominal aortic aneurysm?

A vascular surgeon and a team of specialized health care providers will perform the procedure. Your doctor can explain what to expect for your surgery. This is an example of how it is done:

• You will likely be given general anesthesia. This prevents pain and causes you to sleep through the procedure.
• A healthcare provider will carefully watch your vital signs, like your heart rate and blood pressure, during the procedure.
• Your surgeon will make a small cut in your groin and into an artery there. He or she will then insert a thin, flexible tube (catheter) into the artery.
• The tube will be gently guided all the way to site of the aneurysm. The surgeon will use moving X-ray pictures to get to the right spot.
• A stent graft is sent along the catheter to the aneurysm. The stent graft is a tube made of a thin metal mesh (the stent), covered with a thin polyester fabric (the graft). The tube is collapsed so it is narrow and can fit through your blood vessel.
• When the stent graft reaches the aorta, it is opened up and fastened in place. The stent graft then stays in place, and blood flows through it. It protects that part of the aorta, and prevents the aneurysm from bursting.
• Your surgeon will remove the catheter. The incision in your groin is closed and a small bandage is put on the wound.

What happens after an endovascular repair of an abdominal aortic aneurysm?

After the procedure, you will spend several hours in a recovery room. Your healthcare team will watch your vital signs, such as your heart rate and breathing. To help prevent bleeding, you may need to lie flat for several hours after the procedure. You may need to stay at the hospital for a day or more, depending on your condition. Your healthcare provider will tell you more about what to expect.

You may have some pain after the procedure. You can take pain medication as advised by your doctor. You can eat a normal diet as soon as you are able.

You may need to take it easy for a little while after you get home. Ask your doctor if you need to limit your activities. You may need to take medications to help prevent blood clots. Follow all of your doctor’s instructions about follow-up care. This will help you have a better recovery.

Call your healthcare provider right away if you have

• Bleeding from the incision site that won’t stop
• Pain at the incision site that gets worse
• Warmth or redness at the incision site
• Changes in the color of your leg
• Pain in your chest or abdomen

Make sure to keep all follow-up appointments. You may need regular imaging tests of your aneurysm after the procedure. This is to help make sure the stent is still in place. Over time, the bulge of your aorta should start to shrink.

Work with your doctor to help keep your blood vessels healthy and prevent a new aneurysm. This may include quitting smoking and taking medications to lower your blood pressure.

Next steps

Before you agree to the test or the procedure make sure you know:

• The name of the test or procedure
• The reason you are having the test or procedure
• The risks and benefits of the test or procedure
• When and where you are to have the test or procedure and who will do it
• When and how will you get the results
• How much will you have to pay for the test or procedure