Aortic Aneurysm Repair

The procedure still has an important role in the management of some patients with aortic aneurysms (AAA).

Pre-operative preparation

In order to prepare for this procedure, it is vital that a full medical work-up be obtained to confirm fitness for anaesthesia.

This will involve a number of blood tests, and an assessment of the heart with an ECG, thallium scan, and referral to a cardiologist if there are any concerns about your heart.

Day of procedure

You may be admitted on the morning of the procedure if your work-up has been completed. You will be required to bring ALL of your usual medications.

It is important to fast for at least 6 hours prior to the procedure. For a morning procedure, you will need to fast from midnight, whereas for an afternoon procedure, this will mean fasting from 7am.

Your anaesthetist will consult you prior to the operation, and explain the anaesthetic and its risks to you.

The procedure

A full general anaesthetic is administered, and a tube inserted into your windpipe (trachea) to help with your breathing while you are asleep. A catheter is also inserted into your bladder to help in monitoring your fluid status. This will remain in-situ for the first 48 hours.

The operation is performed through a midline abdominal incision, passing from the chest to the pubic bone.

Heparin is administered to help keep the blood thin. The aorta is clamped above and below the aneurysm. In over 90% of cases, this occurs below the arteries to the kidneys, so there is no interruption in blood flow to the kidneys. Clot adherent to the wall of the aneurysm is removed, and back bleeding from arteries coming off the aneurysm controlled.

In order to restore vascular continuity, a synthetic graft (Dacron) either as a tube or “trouser” is sewn into position. Clamps are released to restore circulation to both legs, usually sequentially and slowly, to allow fluid replacement and maintenance of blood pressure. All vascular joins are checked and any leaks sealed.

Post-operative course

All patients return to the intensive care unit for at least the first 24 hours for stabilisation, correction of any fluid imbalance and to ensure heart and lung function is optimised.

Patients are then transferred to the ward, where oral fluids and diet is slowly re-introduced, and mobilisation commenced. It is a gradual process, but most patients are fit for discharge at about 7 to 10 days following the procedure.