An aortic aneurysm is a bulge or weak spot in the aorta, one of the large arteries through which blood passes from the heart to the rest of the body. Aortic aneurysm repair surgery repairs or removes an aneurysm through an incision in the skin.
Aneurysms in the aorta occur primarily in two places:
- An abdominal aortic aneurysm occurs in the part of the aorta that passes through the middle to lower abdomen.
- A thoracic aortic aneurysm occurs on the aorta as it passes through the chest cavity. These are less common than aortic aneurysms.
What Is Aortic Aneurysm Repair Surgery?
In surgical aneurysm repair, a surgeon repairs or removes an aneurysm through an incision in the skin. An aneurysm also can be repaired by an endovascular approach, (also called stent graft aneurysm repair), which is a minimally invasive procedure offered at The Ohio State University Wexner Medical Center. The best method to repair each aneurysm depends on factors such as the location and shape of the aneurysm and the overall health of the patient.
In a traditional (open) repair, a large cut is made in the abdomen. The abnormal blood vessel is replaced with a stent graft made of synthetic material.
The other approach is called endovascular stent grafting. This is a minimally invasive procedure that is performed inside your aorta using thin, long tubes called catheters. A small puncture is made in the artery in your groin. Then the catheter is used to place a stent graft inside the artery to reinforce the weak spot in the aorta. This procedure can eliminate the need for open surgery. Aortic aneurysms can be monitored or corrected surgically while the bulge is intact but require emergency surgery when they rupture. If your abdominal aortic aneurysm is small, your physician may recommend watching and waiting, which means that you will be monitored every six to 12 months for signs of changes in the aneurysm size.
Why Would You Have an Aortic Aneurysm Repair Surgery?
Emergency surgery may be necessary if an aneurysm is about to rupture or burst or has already ruptured. A physician may recommend emergency surgery if an aneurysm causes symptoms, such as abdominal or back pain, because the aneurysm may be on the verge of bursting. An aortic aneurysm that causes internal bleeding requires open abdominal aortic aneurysm repair.
An aortic aneurysm may or may not cause symptoms or problems. A physician may detect this problem from an ultrasound or CT scan. Physicians and patients must discuss and decide if the risk of surgery is less than the risk of possible bleeding if an aneurysm is not repaired.
What to Expect During Aneurysm Repair Surgery
Preparing for Your Procedure
Prior to surgery, you’ll meet with your physician to discuss your medical history, the medicines you take and any questions you have. Your physician may also schedule routine tests including:
- Ultrasound – A test that uses high-frequency sound waves to evaluate blood flow in a vessel.
- CT scan
- Cardiac MRI (cardiac magnetic resonance imaging or CMR) – A noninvasive, sophisticated imaging procedure that uses large magnets and a computer to produce detailed images of the structure and function of the heart while it is beating.
- CT angiogram (CTA - computed tomography angiogram) – An imaging procedure that uses CT technology to produce cross-sectional, detailed images of blood vessels.
A vascular surgeon will give you instructions to follow before the surgery, such as fasting and when to stop taking medications you normally take.
During Your Procedure
There are two types of aortic aneurysm repair surgeries. You and your surgeon will determine which procedure is right for your condition.
- Open Abdominal Surgery—During this procedure, the surgeon makes an incision in the middle of the abdomen. Once the aortic aneurysm is located, the surgeon places clamps on it, below and above the bulge. The surgeon cuts open the aneurysm and attaches an artificial graft to the sides of the aorta. This tube connects the aorta above and below the aneurysm. After the surgeon wraps the wall of the aneurysm around the graft, the clamps are removed to allow blood to flow. Generally, open repair has higher risks of complications that does endovascular repair.
- Endovascular Surgery—Surgeons at The Ohio State University Medical Center perform minimally invasive endovascular surgery to repair abdominal aortic aneurysms. During this procedure, repairs are made using small incisions in the groin, to avoid a large abdominal or chest incision. Through the femoral artery in the leg, the surgeon inserts a catheter to position an artificial graft inside the aorta. The stent graft provides a permanent alternative path for blood flow, bypassing the aneurysm.
After Your Procedure
You may be connected to the following equipment after surgery:
- A heart monitor
- Oxygen given through a tube in the nose and an oxygen monitor on your finger
- A Foley catheter, a tube that goes into the bladder to drain urine
- An intravenous line (IV) to provide fluids
Your physician may schedule you for an imaging study to make sure that your aneurysm is not redeveloping and that the graft is functioning properly.
You may stay in the hospital for seven to 10 days after your surgery, depending on the site of your incision and your general health. Your physician or vascular surgeon will give you any special instructions you need to follow after the surgery.