Abdominal Aortic Aneurysm Repair

WHAT YOU SHOULD KNOW:

An abdominal aortic aneurysm (AAA) occurs when your aorta weakens and bulges out like a balloon. The aorta is a large blood vessel that extends from your heart to your abdomen. An aneurysm that is too big may burst and need repair. Abdominal aortic aneurysm (AAA) repair is surgery to fix an aneurysm in your abdominal aorta.


CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. 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. You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs or brain. A blood clot in your lungs can cause chest pain and trouble breathing. A blood clot in your brain can cause a stroke. These problems can be life-threatening.

  • Body organs such as your heart, kidneys, and bowels may also be damaged and may stop working. Your spinal cord may be damaged and you may become paralyzed. 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 burst, which is life-threatening. 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 is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

Enema:

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

Medicines:

  • Antibiotics: This medicine is given to help treat or prevent an infection caused by 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 to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.

  • 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 will keep you asleep and free from pain during surgery. Anesthesia may be given through your IV. You may instead breathe it in through a mask or a tube placed down your throat. The tube may cause you to have a sore throat when you wake up.

  • Regional anesthesia: Medicine is injected to numb the body area where the surgery or procedure will be done. You will remain awake during the surgery or procedure.

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 or EKG. Sticky pads placed on your skin record your heart's electrical activity.

  • Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.

  • 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 catheter: This is a balloon-tipped catheter (thin tube) inserted through a vein in your neck or groin. The pulmonary artery (PA) catheter goes into the right side of your heart and continues to your pulmonary artery. The balloon is inflated to wedge the catheter in place. The PA catheter has a device in it that measures the pressure in your heart and lungs. The catheter is attached to a monitor that shows the pressure measurements. The measurements can also show caregivers how your heart responds to certain heart medicines.

  • 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:

  • A Foley catheter is a tube put into your bladder to drain urine into a bag. Keep the bag below your waist. This will prevent urine from flowing back into your bladder and causing an infection or other problems. Also, keep the tube free of kinks so the urine will drain properly. Do not pull on the catheter. This can cause pain and bleeding, and may cause the catheter to come out. Caregivers will remove the catheter as soon as possible to help prevent infection.

  • Nasogastric (NG) tube: An NG tube is put into your nose, and passes down your throat until it reaches your stomach. Food and medicine may be given through an NG tube if you cannot take anything by mouth. The tube may instead be attached to suction if caregivers need to keep your stomach empty.

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 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, 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.

  • Blood sugar tests: Caregivers will monitor your blood sugar closely after surgery. This may help decrease your chance of getting an infection.

  • Bowel movements: Caregivers may give you fiber medicine or a stool softener to help make your bowel movements softer and more regular.

  • Breathing support:

    • You may need extra oxygen if your blood oxygen level is lower than it should be. You may get oxygen through a mask placed over your nose and mouth or through small tubes placed in your nostrils. Ask your healthcare provider before you take off the mask or oxygen tubing.

    • A ventilator is a machine that gives you oxygen and breathes for you when you cannot breathe well on your own. An endotracheal (ET) tube is put into your mouth or nose and attached to the ventilator. You may need a trach if an ET tube cannot be placed. A trach is a tube put through an incision and into your windpipe.

  • You will be able to drink liquids and eat certain foods once your stomach function returns after surgery. You may be given ice chips at first. Then you will get liquids such as water, broth, juice, and clear soft drinks. If your stomach does not become upset, you may then be given soft foods, such as ice cream and applesauce. Once you can eat soft foods easily, you may slowly begin to eat solid foods.

  • Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.

  • 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: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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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