Aortic aneurysm is often diagnosed when you have tests for another reason. If you’re a man over 65, it may be picked up when you’re invited to be screened at your GP surgery or local hospital. The screening programme only covers abdominal aortic aneurysms, not thoracic aortic aneurysms.
Unless your aortic aneurysm ruptures you probably won’t have any symptoms, so finding out you have an aneurysm may be a shock for you. Some people do have pain in their back, tummy, side or groin.
Your doctor may advise you to have surgery if your aneurysm grows to 5.5cm. You may also need surgery if your aneurysm is causing symptoms because this can mean it’s growing fast.
An operation may be lower risk than leaving a large aortic aneurysm untreated because of the chance of it bursting.
You will need to have emergency surgery if your aneurysm ruptures.
If your aneurysm is less than 5.5cm your doctor will probably advise you not to have any treatment. You will need regular ultrasound scans to monitor the size of your aneurysm.
If you need surgery for an aortic aneurysm, your surgeon may recommend that you have open surgery instead of endovascular repair. During open surgery, your surgeon will make a cut in your chest or your abdomen to access your aorta and will insert a graft into the weak area of your aorta.
Your surgeon will explain how to prepare for your operation. For example, if you smoke you will be asked to stop. This is because smoking increases your risk of getting a chest and wound infection, which can slow your recovery.
EVAR usually requires a hospital stay of one to three days and it’s usually done under general anaesthesia. This means you will be asleep during the operation. Alternatively, you may be able to have local anaesthesia. This completely blocks pain from your groin (where the stent will be inserted) and you will stay awake during the operation.
If you're having a general anaesthetic, you will be asked to follow fasting instructions. This means not eating or drinking for about six hours beforehand. However, it's important to follow your anaesthetist’s advice.
Your surgeon will discuss with you what will happen before, during and after your procedure. This is your opportunity to understand what will happen. You can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead. You may be asked to do this by signing a consent form.
EVAR usually takes between two and three hours but this will depend on your individual circumstances. Ask your surgeon for advice.
Your surgeon will make small cuts in your groin and will pass guide wires up the femoral artery to your aorta. Your surgeon will then feed a stent – a metal tube covered with synthetic graft material – along the guide wire to the area of the aneurysm. The stent comes pre-loaded on a delivery system, which your surgeon will use to position the stent graft correctly.
Your surgeon will use X-ray images to guide the wires, confirm the position of your aneurysm and put the stent graft in place. The graft material will bond with your arterial wall and blood will flow through the stent instead of the weakened aneurysm.
You will usually have a CT angiogram to check your blood is flowing correctly through the stent.
Your surgeon will close the cut in your groin. This may be with dissolvable stitches.
After the operation, you will probably be able to return to the hospital ward. Some people go to an intensive treatment unit (ITU) or a high dependency unit (HDU) for closer monitoring before returning to the ward.
You may need pain relief to help with any discomfort as the anaesthetic wears off.
The length of time your stitches will take to dissolve depends on what type you have. They usually disappear within six to eight weeks.
When you're ready to go home, you will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours.
Your nurse will give you some advice about caring for your healing wounds before you go home. You may be given a date for a follow-up appointment.
It usually takes about two weeks to make a full recovery from EVAR. However, this varies for different people, so it's important to follow your own surgeon's advice.
If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.
As with every procedure, there are some risks associated with EVAR. We haven’t included the chance of these happening as they are specific to you and differ for everyone. Ask your surgeon to explain how these risks apply to you.
Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. After EVAR, your groin area (where the stent was inserted) may feel sore for up to a week.
Complications are when problems occur during or after the operation. The possible complications of any operation include:
- an unexpected reaction to the anaesthetic
- excessive bleeding
- developing a blood clot, usually in a vein in your leg (deep vein thrombosis, DVT)
The following are possible complications that are specific to EVAR for an aortic aneurysm.
- The graft may move from its position. This is called graft migration.
- The wires or fabric of the stent graft may break. This is called wire fracture or fabric tear.
- One of the parts of the stent graft may kink or block and clots can form. This is called limb thrombosis.
- Blood may leak outside the stent graft and increase pressure in the aneurysm. This is called endovascular leak (or endoleak).
- You may have kidney failure.
- You may have a stroke.
- Your wound may become infected. If this happens, you may need treatment with antibiotics.
- The graft may become infected. This is very rare but serious, and may mean that your graft will have to be removed.
- Erectile dysfunction can affect some men if nerves in the abdomen are damaged during the operation.
You will need to have regular check-ups for the rest of your life after having endovascular repair.
Can I opt to have an endovascular aneurysm repair instead of open surgery?
Your surgeon will talk to you about whether open surgery or endovascular aneurysm repair (EVAR) will be better for you. EVAR isn't suitable for everybody.
For some people, having EVAR isn't possible. This can be because of the location or shape of the aneurysm, or shape or size of the aorta or arteries in their groin.
Even for people whose aneurysm is suitable for EVAR, open surgery may still be a better option. This is especially true for those who are young and otherwise fit. This is because you need life-long follow-up after EVAR, and there’s a greater risk of needing further treatment. This may outweigh the small benefits of having this type of procedure for many people.
Between six and seven out of 10 people who need surgery for abdominal aortic aneurysm can have EVAR.
How long will my stent graft last after an endovascular aneurysm repair?
EVAR is a relatively new procedure so doctors don't have a lot of information about how well stent grafts last over the long-term. The length of time your stent lasts will depend on many factors, such as the exact type of stent and your health.
You may need further surgery to replace your stent graft if you’ve had complications after the initial procedure. For example, blood leaking from the stent graft. The chance of needing another procedure is higher after EVAR than after an open aneurysm repair.
It isn't known how likely this is to happen over the long term. This is because researchers currently only have information about how people have fared over a period of a few years after their initial procedure.
The long-term success of your operation depends on many factors, such as your overall health and the exact stent you have. This is why your surgeon will want to monitor your progress.
New stents are being developed all the time.
Is surgery the only option if I have an aneurysm?
Surgery is usually only recommended if your aneurysm is at risk of bursting. If the risk of this happening is low, your surgeon will carefully monitor your condition and may suggest you make some lifestyle changes.
Because the operation itself carries some risks, or even death, surgery is usually only recommended if your aneurysm is at risk of bursting. If your aneurysm is small (less than 5.5cm), then it's very unlikely to burst.
Your surgeon will probably suggest you have regular ultrasound checks to see if the aneurysm grows over time. Surgeons call this 'watchful waiting' or surveillance.
Your doctor may also suggest some other measures to try and stop your aneurysm from getting bigger or from bursting. These might include stopping smoking and taking medicines to control your blood pressure and cholesterol. This can slow the build-up of fatty deposits in your arteries, which is often associated with aneurysms.
What follow-up will I need after an endovascular aneurysm repair?
You will need regular check-ups for the rest of your life following an endovascular aneurysm repair (EVAR).
It’s possible for complications to develop after this type of procedure. For example, the stent may move position or it may break. Because of this, you will need lifelong follow-ups to check that your stent is still in place and it’s working properly.
You will usually need to have a follow-up CT angiogram about a month after your procedure, and again after about six months. The exact timings will depend on your health and the type of stent you have. A CT angiogram creates a three-dimensional picture of your body, and uses a dye to show up your aorta. Alternatively, you may have an ultrasound scan to check the stent. You will continue to need yearly checks after this.
If a problem is identified during one of your check-up appointments, your surgeon or doctor will advise if you need to have further tests or surgery.
- Paravastu SCV, Jayarajasingam R, et al. Endovascular repair of abdominal aortic aneurysm. Cochrane Database of Systematic Reviews 2014, Issue 1. doi:10.1002/14651858.CD004178.pub2
- Abdominal aortic aneurysm. PatientPlus. www.patient.co.uk/patientplus.asp, reviewed 13 June 2012
- Thoracic aortic aneurysm. PatientPlus. www.patient.co.uk/patientplus.asp, reviewed 16 May 2012
- Abdominal aortic aneurysm. Medscape. www.emedicine.medscape.com, published 19 November 2014
- Abdominal aortic aneurysm – endovascular stent-grafts. National Institute for Health and Care Excellence (NICE), February 2009. www.nice.org.uk
- NHS abdominal aortic aneurysm screening programme. Public Health England. http://aaa.screening.nhs.uk, accessed 25 January 2015
- Brown LC, Powell JT, Thompson SG, et al. The UK EndoVascular Aneurysm Repair (EVAR) trials: randomised trials of EVAR versus standard therapy. Health Technol Assess 2012; 16(9):1–218. doi:10.3310/hta16090
- Laparoscopic repair of abdominal aortic aneurysm. National Institute for Health and Care Excellence (NICE), 2007. www.nice.org.uk
- Endosovascular aneurysm repair. Circulation Foundation. www.circulationfoundation.org.uk, accessed 2 February 2015
- Karthikesalingam A, Page AA, Pettengell C, et al. Heterogeneity in surveillance after endovascular aneurysm repair in the UK. Eur J Vasc Endovasc Surg 2011; 42(5):585–90. doi:10.1016/j.ejvs.2011.06.053
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Reviewed by Dylan Merkett, Bupa Heath Information Team, March 2015.
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