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 go for a screening test 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. However, some people do have pain in the back, tummy, side or groin.
The larger the aneurysm, the greater the chance it will burst. So your doctor will advise you to have planned surgery if your aneurysm increases to 5.5cm. You may also need surgery if your aneurysm is causing symptoms because this can mean it’s growing fast.
An operation is lower risk than leaving a large aortic aneurysm untreated because of the chance of it bursting, which is often fatal.
You will need to have emergency surgery if your aneurysm ruptures.
If your aneurysm isn’t very large (less than 5.5cm) your doctor or surgeon may advise you not to have any treatment. However, you will need regular ultrasound scans to monitor the size of the aneurysm.
Your surgeon may suggest that you have the procedure using keyhole surgery, but this isn’t suitable for everybody. Your surgeon will let you know if it’s an option for you.
Alternatively, your surgeon may suggest another surgical method called endovascular aneurysm repair (EVAR). However, this method isn’t suitable for everyone. It depends on many factors. These include:
- the shape of your aneurysm
- how near your aneurysm is to other blood vessels
- whether the arteries in your groin are large enough for the stent graft to be inserted
Your surgeon will advise you which procedure is best for you.
Your surgeon will explain how to prepare for your operation. For example, if you smoke, you will be asked to stop. Smoking increases your risk of getting a chest and wound infection, which can slow your recovery.
Open surgery for an aneurysm usually requires a hospital stay of around a week and is done under general anaesthesia. This means you will be asleep during the operation. You will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it’s important to follow your anaesthetist’s advice.
You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs.
Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. 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.
Open surgery can take around three to four hours, or sometimes longer, but this will depend on your individual circumstances.
Your surgeon will make a cut in your chest or your abdomen, depending on where your aneurysm is. They will then open the aorta near to the aneurysm and insert a graft. The graft will be made out of an elastic material.
The graft will fit into the portion of the aorta that is damaged. Your blood will then flow through the graft, reducing pressure on the damaged wall of your aorta by bypassing the area of the aneurysm.
Your surgeon will close the cut in your chest or abdomen with stitches or clips.
After your operation, you will probably be taken to an intensive care unit (ICU) or a high dependency unit (HDU). You will be closely monitored here for a day or two. You may have a tube in your mouth, which passes into your windpipe (trachea) and will be connected to a ventilator to help you breathe. This will be removed once you can breathe by yourself.
You will have pain relief to help with any discomfort as the anaesthetic wears off.
You may have a catheter to drain urine from your bladder into a bag. You may also have fine tubes running out from your wound. These drain fluid into another bag and are usually removed after a day or two.
Once you’re stable, you will be taken back to a normal ward, where nurses will monitor you until you’re ready to go home.
If you have dissolvable stitches, the length of time they will take to disappear depends on the type you have. However, they usually disappear within a couple of months.
When you’re ready to go home, you will need to arrange for someone to drive. Try to have a friend or relative stay with you for the first few days. Your nurse will give you some advice about caring for your healing wound before you go home. You may also be given a date for a follow-up appointment.
It usually takes at least six weeks to make a full recovery but this varies between individuals, so it’s important to follow your surgeon’s advice. You may be off work for about six to 12 weeks.
You will probably feel tired for several weeks after the operation, but this will gradually improve.
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 open surgery for aortic aneurysm. We haven’t included the chance of these happening as they are specific to you and differ for every person. 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 open surgery for an aortic aneurysm, your healing wound will feel sore.
Complications are when problems occur during or after the operation. The following are specific complications of open surgery for aortic aneurysm.
- Kidney failure.
- Heart attack.
- A wound infection. You may need treatment with antibiotics if your wound becomes infected.
- Infection of the graft. This is very rare, but serious, and usually means that your graft will have to be removed.
- Erectile dysfunction. This can affect some men if nerves in the abdomen are damaged during the operation, although often improves within around three months after the operation.
- Bowel problems. The blood supply to the bowel can be reduced and you may need a bowel operation to repair the damaged bowel.
- Incisional hernia. This is when part of the bowel pushes through the weakness in the abdomen caused by the surgical cut.
Can I opt to have endovascular repair instead of aortic aneurysm open surgery?
Your surgeon will advise you about whether open surgery or endovascular aneurysm repair (EVAR) will be better for you. EVAR isn’t suitable for everybody.
For some people, EVAR isn’t possible due to the location or shape of the aneurysm or the size of the arteries in their groin. Even for those people who are suitable for the procedure, open surgery may still be considered the better option. Especially 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 short-term benefit of having this type of procedure for many people. Ask your surgeon for more information.
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.
Surgery is usually only recommended if your aneurysm is at risk of bursting or if you have symptoms. If your aneurysm is less than 5.5cm in diameter, it’s unlikely to burst.
Your surgeon will probably suggest you have regular ultrasound checks to see if the aneurysm grows. Surgeons call this ‘watchful waiting’.
They may also suggest some other steps you can take to stop your aneurysm from getting bigger or bursting. These might include stopping smoking and taking medicines to control your blood pressure and cholesterol. This helps prevent the build-up of fatty deposits in your arteries, which is often associated with aneurysms.
Will I be able to drive after my aortic aneurysm open surgery?
You will be able to drive only when you have fully recovered from your surgery.
You will need to notify the Driving and Vehicle Licensing Agency (DVLA) if you have an aneurysm with a diameter of 6cm or more. However, you will be allowed to continue driving as long as your aneurysm isn’t more than 6.5cm in diameter. In addition, you will need to have had either a satisfactory medical test or surgery to repair the aneurysm.
You shouldn’t drive after surgery until you’re able to perform an emergency stop safely. This may take a few weeks. You should check with your surgeon if you aren’t sure.
- Abdominal aortic aneurysm. Patient UK Professional Reference. www.patient.co.uk, published 13 June 2012
- Abdominal aortic aneurysm. Medscape. www.emedicine.medscape.com, published 19 November 2014
- Abdominal aortic aneurysm – endovascular stent-grafts, NICE Technology Appraisal Guidance (February 2009). National Institute for Health and Care Excellence (NICE), published February 2009. www.nice.org.uk
- Thoracic aortic aneurysms. PatientPlus. www.patient.co.uk/patientplus.asp, published 16 May 2012
- Simon C, Everitt H, van Dorp F, Burkes M. Oxford handbook of general practice. 4th ed. Oxford: Oxford University Press; 2014. doi:10.1093/med/9780199671038.003.0010
- NHS Abdominal Aortic Aneurysm Screening Programme. Public Health England. aaa.screening.nhs.uk, accessed 25 January 2015
- Laparoscopic repair of abdominal aortic aneurysm. National Institute for Health and Care Excellence (NICE), August 2007. www.nice.org.uk
- Brown L, Powell J et al. The UK EndoVascular Aneurysm Repair (EVAR) trials: randomised trials of EVAR versus standard therapy. Health Technology Assessment 2012; 16(9):218.
- Paravastu SCV, Jayarajasingam R, Cottam R, Palfreyman SJ, Michaels JA, Thomas SM. Endovascular repair of abdominal aortic aneurysm. Cochrane Database of Systematic Reviews 2014, Issue 1. doi:10.1002/14651858.CD004178.pub2
- Open AAA repair operation. Circulation foundation. www.circulationfoundation.org.uk, accessed 11 February 2015
- For medical practitioners: at a glance guide to the current medical standards of fitness to drive. Driver and Vehicle Licensing Agency. www.gov.uk, published November 2014
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