Abdominal Aortic Aneurysm
MEDICAL ANIMATION TRANSCRIPT: Your surgeon will perform an abdominal aortic aneurysm repair to prevent the rupture of a bulging area of your aorta. The largest artery in the body is the aorta, which is attached to the heart and receives blood directly from the left ventricle, or main pumping chamber. The aorta is divided into four parts: the ascending aorta, aortic arch, thoracic aorta and the abdominal aorta. The abdominal aorta is the last and largest section of the aorta. It supplies blood to the lower regions of your body, including the organs in the abdomen and pelvis. The abdominal aorta ends around navel level, where it splits into the two iliac arteries that carry blood to the legs. The aorta has a thick wall so it can withstand the high pressure of blood being pumped from the heart. Over time, the wall of the aorta may weaken, slowly bulging outward like a balloon. When this condition occurs in the abdominal region it is called an abdominal aortic aneurysm. Your surgeon will perform an open abdominal aortic aneurysm repair when the diameter of you aorta exceeds 2 inches, or if you are having symptoms such as intense abdominal pain or an abnormally prominent abdominal pulsation. Before the open procedure, an IV line will be started to provide you with fluids, antibiotics, and anesthesia. A traditional open surgical repair is performed under general anesthesia which means you will be asleep for the duration of the procedure. A breathing tube will be inserted through your mouth and into your windpipe to help you breathe during the operation. When you are asleep, a catheter will be inserted into your bladder to drain your urine and monitor your kidney function. Your surgeon will begin by making an incision from the breastbone to below the navel. He or she will then locate the aneurysm and clamp the aorta just above and below it. Your surgeon will then open the aneurysm and sew an artificial graft, the same size and shape as a healthy aorta, into place. Your surgeon will stitch the wall of the aneurysm closed over the newly placed graft. The graft will reinforce the walls of the aorta. Your surgeon will close the abdominal incision with stitches. The total length of this procedure is usually four to six hours. You surgeon will perform endovascular aneurysm repair, a newer minimally invasive procedure, if you have severe heart disease or are at increased surgical risks due to age or other medical conditions. Before the endovascular procedure, as with the open procedure, an IV line will be started to provide you with fluids and antibiotics. You may receive general anesthesia or you may receive a sedative and an epidural or a regional anesthesia to numb only the lower half of your body. Your surgeon will begin by making a small incision in your groin over your femoral artery. Then he or she will insert a guidewire into the artery and gently push it up toward the sight of your aneurysm. A catheter, or hollow tube, will be passed over the guidewire and pushed toward your aneurysm. Using live x-ray pictures as a guide, your surgeon will pass an endovascular stent graft, a compressed fabric and metal tube, through the catheter to the aneurysm Then he or she will open the graft, which will be held in palce with metallic hooks and stents. Your surgeon may insert additional graft components to extend the graft into the blood vessels supplying your legs. Once the graft is in place your blood will flow through it, not into the surrounding aneurysm sac, which will remove the pressure from your aneurysm. Finally, your surgeon will remove the catheters and close the incisions in your groin. The procedure will generally take two to three hours. After your procedure if you had a breathing tube it will be removed and you will be taken to the intensive care unit for recovery. You will receive fluids and nutrition through your IV. You may also have a tube inserted through your nose and into your stomach to remove secretions until your intestine regain normal functioning. The usual hospital stay for an open procedure is five to ten days, while the stay for an endovascular procedure is usually shorter at two to three days.