Abdominal Aortic Aneurysm Repair

WHAT YOU SHOULD KNOW:

• Abdominal aortic aneurysm (AAA) repair is surgery to fix an aneurysm in your abdominal aorta. The aorta is a large artery from your heart that runs down through your chest and abdomen (stomach). An aortic aneurysm is a weak, stretched, and widened part of your aorta. It is called an abdominal aortic aneurysm (AAA) if it occurs in your abdomen. If your AAA occurs with an aneurysm in your chest, it is called thoracoabdominal aortic aneurysm (TAAA). An aneurysm that is too big, causes symptoms, or is likely to rupture (burst) will need repair.
  
  
• AAA repair may be done in different ways depending on where your aneurysm is located. Your caregiver may make an incision (cut) in the middle of your abdomen. The midline incision may start at your chest and go down to your abdomen. Your caregiver may also do an incision across the left side of your abdomen. The aneurysm is then cut open, cleaned out, and removed. A graft (man-made tube) is sewn in and replaces the removed aneurysm to allow for normal function.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

RISKS:

• During your AAA repair, you may bleed more than usual. Other organs or tissues near your aorta may be damaged, and you may get an infection. Blood clots may form which could cause you to have trouble breathing. Blood clots may also block blood flow to other parts of your body. Body organs such as your heart, kidneys, and intestines (bowels) may also be damaged and may stop working. Your spinal cord may be damaged and you may become paralyzed (unable to move). Your AAA could rupture during the surgery, and you could die. People who smoke, or have kidney, lung, or heart disease are at a higher risk of problems.
  
  
• Without treatment, your AAA may grow larger. This may press on other parts of your body and cause poor blood flow and blood clot formation. Blood clots may block blood from getting to areas of your body. If this happens, it may cause the tissues of the body part to die. An AAA that keeps growing may leak blood around your aorta, other blood vessels, or into your abdomen. It may cause the AAA to rupture (burst), and you could die. Call your caregiver if you are worried or have questions about your surgery, condition, or care.

WHILE YOU ARE HERE:

Before your surgery:

Informed consent: You have the right to understand your health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your condition. Your doctor should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.

Enema: You may need to have an enema before your surgery. This is liquid put into your rectum to help empty your bowel.

IV: An IV is a tube placed in your vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.

Medicines:

• Antibiotics: Antibiotics may be given to help treat or prevent an infection caused by germs called bacteria.
  
  
• Beta blocker: This medicine keeps your heart pumping strong and regular. Beta blockers may be given if you have a heart disease to decrease your risk of problems after surgery.

Tests:

• Blood tests: You may need blood taken for tests. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. It is tested to see how your body is doing. It can give your caregivers more information about your health condition. You may need to have blood drawn more than once.
  
  
• Computed tomography scan: This test is also called a CT scan. A special x-ray machine uses a computer to take pictures of your abdominal area. Before taking the pictures, you may be given x-ray dye through an IV in your vein. X-ray dye helps the aneurysm show up better in the pictures. Tell your caregiver if you are allergic to shellfish (lobster, crab, or shrimp), because you may be allergic to this dye.
  
  
• Magnetic resonance imaging: This test is also called a MRI. A large magnet and a computer are used to take pictures of your body. During the MRI, you may also have a test called magnetic resonance angiography or MRA. You will be given dye if MRA is to be done.

Pre-op care: You may be given medicine to make you feel relaxed and sleepy right before your surgery. You are taken on a stretcher to the room where your surgery will be done. You will then be moved to an operating table or bed. You will receive medicine called anesthesia to make you comfortable during surgery:

• General anesthesia: This is medicine that may be given in your IV or as a gas that you breathe. You may wear a face mask or have a tube placed in your mouth and throat. This tube is called an endotracheal tube or ET tube. Usually you are asleep before caregivers put the tube into your throat. The ET tube is usually removed before you wake up. You are completely asleep and free from pain during surgery.
  
  
• Spinal or epidural anesthesia: This is medicine put into your back to numb you below the waist. With spinal anesthesia, the medicine is given through a shot. Feeling returns in about two hours. Epidural anesthesia is put into your back through a tiny tube. The tube may be left in place to give you more medicine later if needed. After epidural anesthesia, feeling returns to your legs when the medicine wears off.

Monitoring: This helps your caregiver check how your body is doing during the surgery.

• Cerebral: Special machines may be used to make sure your brain is getting enough oxygen and blood.
  
  
• Cerebrospinal fluid drain: Caregivers may insert a tube in your back and into your spine if you will have a TAAA repair. Cerebrospinal fluid (CSF) may be drained during surgery to decrease pressure and prevent damage to your spinal cord. CSF is a clear fluid that flows around the brain and inside the spinal canal.
  
  
• Heart monitor: This is also called an ECG. Sticky pads are placed on different parts of your body. Each pad has a wire that is hooked to a TV-type screen. This shows caregivers a tracing of the electrical activity of your heart.
  
  
• Pulse oximeter: A pulse oximeter is a machine that tells how much oxygen is in your blood. A cord with a clip or sticky strip is placed on your ear, finger, or toe. The other end of the cord is hooked to a machine. Caregivers use this machine to see if you need more oxygen.
  
  
• Special lines: Special IV lines are usually inserted after you are asleep.
  
  
  • Arterial line: An arterial line is a tube that is placed into an artery (blood vessel), usually in the wrist or groin. The groin is the area where your abdomen meets your upper leg. An arterial line may be used for measuring your blood pressure or for taking blood.
    
    
  • CVP line: A CVP line is also called a central line. It is an IV catheter or tube. It is put into a large blood vessel near your collarbone, in your neck, or in your groin. The groin is the area where your abdomen meets your upper leg. The CVP line may be used to give medicines or IV fluids. It may also be hooked up to a monitor to take pressure readings. This information helps caregivers check your heart.
    
    
  • Pulmonary artery line: A pulmonary artery line, or PA cath, is a kind of central line catheter. It is a thin tube put in a vein near your collarbone, or in your neck or groin. The tube is then guided through your heart and into a blood vessel that goes to your lungs. One end of this catheter is hooked to a machine called a monitor. The monitor shows numbers that tell caregivers how your heart and lungs are doing. The part of this catheter that is inside you may be used to give you medicine. You will need a chest x-ray after the PA line is placed, to be sure the line is where your caregiver wants it. You may have stitches on your skin where the line comes out. This holds the line in place.
  
  
• Transesophageal echocardiogram: A transesophageal echocardiogram (TEE) is a type of ultrasound that shows pictures of the size and shape of your heart. This may be used to check the blood flow to you heart.

Tubes: After you are asleep, caregivers may insert the following tubes:

• Foley catheter: A Foley catheter is a tube that is put into your bladder to drain your urine into a bag. The bladder is an organ where urine is kept. Keep the bag of urine well below your waist. Lifting the urine bag higher will make the urine flow back into your bladder, which can cause an infection. Avoid pulling on the catheter because this may cause pain and bleeding, and the catheter may come out. Do not allow the catheter tubing to kink because this will block the flow of urine.
  
  
• Nasogastric (NG) tube: A nasogastric tube is put into your nose and down into your stomach. The tube may be attached to suction (vacuum) to keep your stomach empty. You may need a NG tube if your stomach gets too full or if you throw up a lot after surgery. You may also need it if you cannot use your mouth to eat. An NG tube may also be used to help get your bowels working. Food or medicine may be given through your NG tube.

During your surgery:

• Your skin is cleaned with soap and water, and covered with sheets. You are placed lying on your back, or lying on your right side with your left side up. You may have warm sheets or blankets on you during surgery to keep your body temperature normal. An incision is made to open your abdomen and reach the AAA. Once it is seen, a clamp is placed on the aorta above the aneurysm. This stops the blood from flowing through the area where the surgery will be done. You may need to be hooked to a machine that acts like your heart and lungs during surgery. This will help move blood through your body and keep your oxygen levels where they should be.
  
  
• The AAA is opened and plaques, such as fat and cholesterol, are removed from your aortic walls. Once the weakened part of the aorta is cut out a graft will replace it. The ends of the graft are sewed to the aorta, above and below the AAA area. A blood thinning medicine to stop clots from forming inside the graft is given. You may also need medicines during surgery to keep your blood pressure normal. The clamp is then removed and blood flow through the graft is checked. Your caregiver also checks for bleeding and damage to other organs nearby. The incision is closed with sutures (stitches or staples) and covered with a bandage.

After your surgery: You will be taken to the recovery room or your hospital room which may be in intensive care. Caregivers will check you often, and you may be on monitors that your caregivers watch outside your room. You will be monitored for any infection or other problems after your surgery. Your caregiver may have you on certain medicines after your surgery to keep your heart working well. You may also be ordered antibiotics to stop infection from starting. Tell your caregiver if you have bloody diarrhea (loose bowel movement), pain in your abdomen, or chest pain. Do not get out of bed until your caregiver says it is OK. Your family may be allowed to visit you in the ICU several times a day.

• Bowel movements: Caregivers may give you fiber medicine or a stool softener to help make your BM's softer and more regular.
  
  
• Breathing support:
  
  
  • Oxygen: You may need extra oxygen to help you breathe easier. It may be given through a plastic mask over your mouth and nose. It may be given through a nasal cannula, or prongs, instead of a mask. A nasal cannula is a pair of short, thin tubes that rest just inside your nose. Tell your caregiver if your nose gets dry or if the mask or prongs bother you. Ask your caregiver before taking off your oxygen. Never smoke or let anyone else smoke in the same room while your oxygen is on. Doing so may cause a fire.
    
    
  • Ventilator: A ventilator is a special machine that can breathe for you if you cannot breathe well on your own. You may have an endotracheal tube (ET tube) in your mouth or nose. A tube called a trach may go into an incision (cut) in the front of your neck. The ET tube or trach is hooked to the ventilator. The ventilator can also give oxygen to you.
  
  
• Diet: You may be able to eat when bowel sounds are heard. Your caregiver will listen to your stomach for bowel sounds using a stethoscope. You may be given ice chips at first, and then liquids such as water, broth, juice, or soda pop. If you do not have problems after drinking liquids, caregivers may then give you soft foods. Some examples of soft foods are ice cream, applesauce, or custard. Once you can eat soft food easily, you may begin eating your usual diet.
  
  
• Heart monitor: This is also called an ECG, electrocardiogram, or telemetry. Sticky pads are placed on your chest or different parts of your body. Each pad has a wire leading to a small portable box (telemetry unit), or to a TV-type screen. This lets caregivers see a tracing of the electrical activity of your heart. The heart monitor may help caregivers see problems with the way your heart is beating. Do not remove any wires or sticky pads without asking your caregiver first.
  
  
• Intake and output: Your caregivers may need to know the amount of liquid you are getting. They may also need to know how much you are urinating. This will help caregivers know if you kidneys are working well. Ask caregivers if they need to measure or collect your urine before you dispose of it.
  
  
• Vital signs: This includes taking your temperature, blood pressure, pulse (counting your heartbeat), and respirations (counting your breaths). To take your blood pressure, a cuff is put on your arm and tightened. The cuff is attached to a machine which gives your blood pressure reading. Caregivers may listen to your heart and lungs by using a stethoscope. Your vital signs are taken so caregivers can see how you are doing.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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