Endovascular Abdominal Aortic Aneurysm Repair

WHAT YOU SHOULD KNOW:

• The aorta is a large artery that runs down the center of your chest and abdomen (stomach). Weakness and stretching of the section of aorta that runs through the abdomen is called an abdominal aortic aneurysm. As an aneurysm grows larger, there is greater risk of it bursting. A burst aneurysm is a very serious medical condition. Endovascular (en-doh-VAS-ku-ler) abdominal aortic aneurysm (AAA) repair is a procedure done to fix the aneurysm in your abdomen.
  
  
• During this procedure, a stent graft (hollow mesh tube) is inserted into your AAA. The stent allows blood to flow normally through your body. It also keeps the pressure of your blood from pushing against the AAA and making it weaker and bigger.

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 an endovascular AAA repair, you may bleed more than usual, get an infection, or have trouble breathing. The arteries where the catheters were put may be damaged. Your groin may be bruised. The procedure may cause blood clots or air bubbles to be in your blood. These could cause a stroke or a heart attack. Body organs such as your kidneys, lungs, and liver may be damaged and may stop working. Your AAA could rupture (break open) during the procedure. If caregivers cannot fix your AAA with this procedure, they may need to do open surgery.
  
  
• Even after the procedure, your AAA may grow over time. Blood may leak between the graft and the AAA. This may make the AAA grow weaker and larger. It may even cause the AAA to rupture, and you could die. The stent may move out of place, break, or bend and block blood flow. You may get leaks between your aorta and other blood vessels or into your abdomen. Call your caregiver if you are worried or have questions about your procedure, medicine or care.

WHILE YOU ARE HERE:

Before your procedure:

Informed consent:

A consent form 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.

Heart monitor:

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

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.

Antibiotics:

This medicine is given to help treat or prevent an infection caused by bacteria.

Lines:

• 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.
  
  
• Central venous line: A central line is a special IV catheter or tube. It is put into a large vein (blood vessel) near your collarbone, in your neck, or in your groin. You may need a central line to receive medicines or IV fluids, or to have blood samples taken. The central line may be used to help caregivers know how your body is doing during and after surgery.

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.

Pre-op care:

You will lie on a hard movable x-ray bed. There will be large x-ray machines and other equipment in the room. You may be given medicine in your IV to help you relax. Soap is used to clean the skin on your abdomen and groin. Your groin is the area where the top of your leg meets your abdomen. The hair in this area may also need to be removed. You will receive anesthesia:

• General anesthesia: Caregivers use this medicine to keep you asleep and free from pain during surgery. They give you anesthesia through your IV or as a gas. You may breathe in the gas through a mask or through a breathing tube placed down your throat. The tube may cause you to have a sore throat when you wake up.
  
  
• Local or monitored anesthesia: Anesthesia is medicine that keeps you from feeling pain during surgery or a procedure. Local anesthesia is a shot of numbing medicine put into the skin where you will have surgery. You will be fully awake during the surgery or procedure. You may feel pressure or pushing, but you will not feel pain. Monitored anesthesia means you will also be given medicine through an IV. This medicine keeps you comfortable, relaxed, and drowsy during the surgery or procedure.
  
  
• 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.

During your procedure:

Caregivers will make an incision (cut) on both sides of your groin. A tube is put through your skin and into an artery (blood vessel) inside your groin. Through this tube a catheter is placed into your AAA. Your caregiver will do x-rays or other tests to take pictures of your AAA. Dye is used to help your AAA show better in the pictures. A device called a stent graft is left inside your AAA to help prevent it from rupturing.

After your procedure:

Tight pressure bandages will be put over the arteries of your groin. Your vital signs will be checked and caregivers will check your bandages often for bleeding. Your skin temperature and pulses found in your legs will also be checked often. Tell caregivers if you feel warmth or wetness in your groin area. This may mean an artery is still bleeding.

• Activity: Lie in bed and keep your legs straight after the procedure. Do not get out of bed until your caregivers say it is OK. When you may get up, ask someone to walk with you in case you feel weak or dizzy.
  
  
• Blood sugar tests: Caregivers will monitor your blood sugar closely after your procedure. This may help decrease your chance of getting an infection.
  
  
• Deep breathing and coughing: Deep breathing opens the tubes going to your lungs, and helps prevent a lung infection. Deep breathe and do several small coughs every hour while you are awake. Also do this if you wake up during the night. When you cough, reach down and put pressure on your groin dressing. This may help prevent bleeding from the surgery.
  
  
  • Take a deep breath and hold the breath as long as you can. Then push the air out of your lungs with small coughs. Put any sputum (spit) you have coughed up into a tissue. Take 10 deep breaths in a row every hour while awake.
    
    
  • You may be given an incentive spirometer. An incentive spirometer helps you take deeper breaths. Put the plastic piece in your mouth and take a very deep breath. Hold your breath as long as you can. Then let out your breath. Use your incentive spirometer 10 times in a row every hour while awake.
  
  
• Eating: You may be given liquids such as water, broth, juice, and soda at first. If you do not have problems after drinking liquids, caregivers may 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.
  
  
• Ice: Ice causes blood vessels to get smaller. When vessels are smaller you may have less pain, swelling and redness. Ice is best started after the procedure and for 24 to 48 hours afterwards. Caregivers put crushed ice in a plastic bag and cover it with a towel. Place the ice pack over the area for 15 to 20 minutes every hour as long as you need it. Do not sleep on the ice pack because you can get frostbite.
  
  
• Medicines: After the procedure, caregivers may give you the medicine you were taking before coming to the hospital. You may also be given one or more of the following medicines:
  
  
  • Antinausea medicine: This medicine may be given to calm your stomach and to help prevent vomiting.
    
    
  • Pain medicine: Caregivers may give you medicine to take away or decrease your pain.
    
    
    • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.
      
      
    • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.
  
  
• Foley catheter: This is a tube caregivers put into your bladder to drain your urine into a bag. Keep the bag below your waist. This will help prevent infection and other problems caused by urine flowing back into your bladder. Do not pull on the catheter, because this may cause pain and bleeding, and the catheter could come out. Keep the catheter tubing free of kinks so your urine will flow into the bag. Caregivers will remove the catheter as soon as possible, to help prevent infection.
  
  
• Pneumatic boots: Inflatable boots are put on your legs. The boots are connected to an air pump. The pump tightens and loosens different areas of the boots. This helps improve blood flow to prevent clots.
  
  
• Pressure stockings: These are long, tight stockings that put pressure on your legs to promote blood flow and prevent clots. You may need to wear pressure stockings before or after surgery or if you have poor circulation (blood flow).
  
  
• 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.

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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.