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Aortic Aneurysm Repair

What is an Aneurysm?

The aorta is the large artery that stems from the heart and carries blood to the rest of the body. The part of the artery that comes out of the heart and travels through the chest is called the thoracic aorta, and the part of the aorta that travels through the abdomen, or stomach area, is called the abdominal aorta. At the navel (bellybutton) the aorta splits into two arteries called the iliac arteries. Smaller arteries, like the renal arteries, branch off the aorta to carry blood to the kidneys and other organs.

An aneurysm forms when a part of the thoracic or abdominal aorta weakens and the wall stretches and expands like a balloon. As it balloons outward, the wall of the aorta becomes thinner and weaker. If the wall becomes too thin it may tear open or rupture causing massive internal bleeding which is a life threatening situation. Sometimes, the aneurysm is dissecting. This occurs when the layers of the aortic wall tear and separate from each other and blood fills the layers between the aortic walls.

Ascending aortic anurysm	Desending throracic aortic anurysm
Abdominal aortic anurysm	Thoracoabdominal aortic anurysm

What causes an aneurysm?

A build up of fatty materials in the blood vessel can form a hard substance called plaque on the aortic wall. Plaque destroys the elastic support of the artery wall causing it to weaken. Cigarette smoking, high blood pressure and irritation of the artery wall can further contribute to the weakening of the aortic wall.

How do I know if I have an aneurysm?

Often, aortic aneurysms produce no symptoms until they rupture. A pulsation in the abdomen may be found on physical exam, or a bulge may show up on an x-ray film or sonogram. Many times they are diagnosed during an exam for another purpose. Acute symptoms of dissection or rupture can include chest or back pain (between the shoulders, or lower back). Any sudden onset of chest pain should warrent immediate medical attention.

Preparing for the elective procedure

Patients will be asked to come into the hospital's Same Day Admission Program a day or two before surgery to have lab work, a chest x-ray, an EKG and a physical exam. A nurse practitioner or physician assistant will discuss the risks of surgery and ask you to sign a consent form. They will also talk with you and your family about what you can expect while you are in the hospital. An Anesthesiologist will talk with you about your medical history and will explain how medication will be given to keep you asleep and free of pain during your surgery.

Patients will also be asked to do the following:

• Stop taking aspirin or certain other medications 5 days before surgery, since they can cause excessive bleeding during surgery.
• If you smoke, stop immediately.
• Do not eat or drink anything after midnight the night before surgery

During the procedure

Your Inova Surgeon will make an incision in the abdomen. The aorta is exposed and the aneurysm is replaced with a synthetic tube. The incision is then closed with sutures.

After the procedure

Immediately after surgery, you will go to the Recovery Room where your vital signs and incision will be constantly monitored. Once awake, you will go to the cardiac unit. There will be a tube in the stomach and bladder. You will be fed intravenously for a few days until the function of your intestines returns to normal. Pain medication will be given by a special intravenous pump that the patient can control, or a nurse can provide pain medication. After surgery, you will remain in the hospital for 3-5 days or until you are able to eat solid foods and walk around the room.