Open repair is the conventional treatment option for patients with an abdominal aortic aneurysm (AAA). The operation is performed via an abdominal incision and involves sewing a prosthetic (synthetic) graft in to the aorta to replace the aneurysm sac.
Figure 1: Open AAA Repair
Open repair may be chosen over endovascular (minimally-invasive) repair for young fit patients, or for those with anatomy which is not suitable for an endovascular approach.
Preparing for the Procedure:
Prior to open AAA repair, all patients need a high-resolution CT scan, a baseline set of blood tests and an echocardiogram (ultrasound of the heart). Some patients require respiratory (lung) function tests. You will be seen by an anaesthetist before the operation for assessment and review of all test results.Unless otherwise specified, all regular medications are continued prior to the procedure. Mr Milne will give you specific instructions regarding anti-platelet medications (e.g. aspirin and clopidogrel), anti-coagulant medications (e.g. warfarin and Rivaroxaban), and any medications taken for diabetes.
Bring a small suitcase with you to the hospital in preparation for a five to seven night stay.
Description of the Procedure:
The procedure is performed under general anaesthetic.An incision is made along the midline of the entire abdomen. The small bowel is mobilised and moved to the side to allow dissection of the aorta, which runs just in front of the spine. The aorta divides in to two iliac arteries at the level of the umbilicus. These arteries travel to the legs, and may be dissected also if they are aneurysmal.
A clamp is placed above the aneurysm sac and on each iliac artery to isolate the aneurysm. The aneurysm sac is opened and any back-bleeding blood vessels are oversewn. A prosthetic graft is then selected to sew in to place and replace the aneurysm. It may be a tube graft (straight) or a bifurcated graft (with trouser legs), depending on the anatomy of the aneurysm. The top of the graft is sewn to normal artery above and normal artery (or arteries) below.The clamps are then released and the graft checked for haemostasis. The aneurysm sac is then closed over the prosthetic graft to act as an envelope around the graft. The bowel is checked and placed back in to its normal position.
The abdomen is then closed with very strong sutures and the skin is closed with a dissolvable stitch underneath the skin.
Following the Procedure:
You will be transferred to the intensive care unit for monitoring after the procedure.On the first day after the procedure, you will be sore along the incision line in the abdomen. Pain relief will be given to minimise this and you will be encouraged to sit up and start with chest physiotherapy. If comfortable, you will be able to sit out of bed in a chair.
It is expected that the bowels will take several days to 'wake up' after being handled during the procedure. You will therefore only be allowed to sip on water for the first day.Over the following days, you can expect to be transferred back to the vascular ward. You will progressively increase your oral intake to fluids, followed by solids if tolerated. You will also be encouraged to walk and continue chest exercises with the physiotherapist.
The aim for discharge from hospital is roughly five to seven days after the procedure. Occasionally, a longer stay is required if issues have arisen.You will be scheduled for a review appointment with Mr Milne 4 - 6 weeks after the procedure.
After this, you will be reviewed at 6 months and 12 months post-operatively.
You may travel short distances, under 4 hours, 4 weeks following the procedure. It is ideal to avoid flights/train/car travel over 4 hours duration for 6 weeks following the procedure. It is important to stay hydrated and walk around the cabin regularly whenever flying.
I acknowledge the travel restrictions following this procedure Signed:___________________________ Date:____________________
Possible Complications of the Procedure:- Pain/bruising:
Return to the Treatment Options for Aortic Aneurysms page.
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