Aortic aneurysm
Endovascular Abdominal Aortic Aneurysm Repair (EVAR)
Why it’s done?
If you have an abdominal aortic aneurysm that:
- Has reached the threshold for repair (5 – 5.5cm)
- Is painful or tender
- Has ruptured
- Has a suitable shape that enables the EVAR graft to seal above and below the aneurysm
Description
The surgery is performed under general or spinal anaesthetic. A small 1cm incision is made in each groin over the femoral arteries. Under ultrasound the femoral arteries are accessed with a needle. A wire is fed through the needle into the femoral artery and then a small plastic sheath is inserted. The EVAR graft is then inserted through the femoral artery over the wire into the aorta. Using x-ray imaging and x-ray dye the graft is positioned above the aneurysm but below the kidney arteries. The graft is then deployed by pulling back the sheath around it allowing it to expand and seal the aorta. The graft is then extended with additional graft limbs that seal in the arteries to each leg (iliac arteries). A large balloon is then inflated within the grafts to ensure that they have fully expanded and sealed the aneurysm with no leaks. Stitches are then used to close the femoral arteries and a dissolving stitch is placed in the skin.
Risks:
- Bleeding
- Infection of the wound
- Infection of the graft
- Endoleak – flow into the aneurysm outside the graft
- Kidney failure
- Narrowing or blockage of the graft
- Heart attack
- Pneumonia
- Deep vein thrombosis/pulmonary embolism
- Need for additional procedures in the future to keep the aneurysm sealed
What can I expect after treatment?
You will be discharged home after 2 – 3 days.
You will have some mild groin pain and bruising.
You will be able to resume normal activities after 48 hours.
After 2 weeks you can resume exercise and strenuous activities.
You will be able to resume driving after 2 weeks.
Your EVAR graft will be monitored for the rest of your life with regular ultrasounds (once a year).
Open Abdominal Aortic Aneurysm Repair
Why it’s done?
If you have an abdominal aortic aneurysm that:
- Has reached the threshold for repair (5 – 5.5cm)
- Is painful or tender
- Has ruptured
- Is not suitable for EVAR
Description
The surgery is performed under general anaesthetic. A large incision is made down the centre of your abdomen. The aortic aneurysm is exposed at the back of your abdominal cavity. Vascular clamps are placed above and below the aneurysm. The aneurysm is then opened and a new synthetic aorta is sewn to the aorta above and below the aneurysm. The synthetic aortic graft is made from Dacron (a type of polyester). The aneurysm wall is then closed over the synthetic aorta and the abdominal wall and skin are stitched closed.
Risks
- Bleeding
- Infection of the wound
- Infection of the graft
- Hernia
- Kidney failure
- Narrowing or blockage of the graft
- Damage to other abdominal organs
- Retrograde ejaculation
- Impotence
- Heart attack
- Pneumonia
- Deep vein thrombosis/pulmonary embolism
What can I expect after treatment?
You will be managed in the intensive care unit for the first few days after your surgery.
You will have significant pain related to the abdominal wound.
You will need to perform breathing exercises to keep your lungs working well.
You will be in hospital for 7 – 10 days.
You be able to resume normal activities after 2 – 3 weeks.
You will be able to resume strenuous activities after 6 weeks.
You will be able to resume driving after 6 weeks.
It will take you several months to fully recover from an open abdominal aneurysm repair.