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Aneurysm Repair

Last updated March 3, 2019

Illustration of a aneurysm of a blood vessel.


Background Information:

What are the other Names for the Procedure?

  • Surgical Aneurysm Repair

What is the Aneurysm Repair surgical procedure?

  • Aneurysm Repair is a surgical procedure involving the removal or repair of an aneurysm
  • An aneurysm is an abnormal widening or blood-filled bulge in the artery caused by weakening of the arterial wall

What part of the Body does the Procedure involve?

An aneurysm can form on any artery, in any part of the body. The Aneurysm Repair procedure is thus confined to the affected artery of the body.

Why is the Aneurysm Repair surgical procedure Performed?

  • An Aneurysm Repair procedure is performed to prevent rupture and hence hemorrhaging of the aneurysm
  • Additionally, if the aneurysm enlarges to the extent of causing pressure on the neighboring tissues and organs, it is better to have it repaired as early as possible

What are some Alternative Choices for the Procedure?

  • If the aneurysm has grown to a size that there is a possibility of imminent rupture, then surgery is the best and most effective option
  • However, the type of surgery depends on the condition of the aneurysm and can be decided after consulting the physician

What are the Recent Advances in the Procedure?

The recent advancement in Aneurysm Repair is the use of endovascular surgical techniques, known as Endovascular Aneurysm Repair (EVAR). This technique is a more recent development as compared to Open Aneurysm Repair.

What is the Cost of performing the Aneurysm Repair surgical procedure?

The cost of Aneurysm Repair procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities. 

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary. 

When do you need a Second Opinion, prior to the Procedure?

  • It is normal for a patient to feel uncomfortable and confused by the information regarding Aneurysm Repair procedure and on what needs to be done
  • If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
  • They can also choose to approach another physician independently. Besides, if the procedure has many alternatives, the patient may take a second opinion to understand and choose the best one

What are some Helpful Resources?

http://www.vascularweb.org/vascularhealth/Pages/surgical-aneurysm-repair.aspx

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002109/

http://www.texasheartinstitute.org/hic/topics/proced/asurg.cfm

Prior to Aneurysm Repair surgical procedure:

How is the Aneurysm Repair surgical procedure Performed?

Aneurysm Repair is performed under general anesthesia. Treating an aneurysm is completely dependent upon its size and location. These factors also dictate the kind of repair the medical experts will adopt.

  • In an Open Repair, the surgeon makes an incision through the skin, fat, muscles, neighboring tissue, and body organs to locate the aneurysm on the artery
  • The affected artery is isolated and clamped, just above and below the aneurysm spot. It is then opened to remove blood clots and plaque, and replaced with a synthetic graft
  • The graft is sewn to the healthy stumps of the artery and it is checked to ensure proper blood flow
  • The incision is closed layer by layer and finally the skin is closed, with sutures or staples and bandaged

Alternatively, an Endovascular Aneurysm Surgery may be performed as this is less invasive:

  • It involves the insertion of a catheter through the femoral artery
  • The catheter carries the graft, which is a metal mesh stent, through the arteries to the point where the aneurysm is located
  • It is guided through with the aid of X-ray imaging (fluoroscopy) and a radio contrast solution, injected into blood
  • Once the stent is placed on the arterial wall with the support of hooks, the catheter is withdrawn; the skin is closed and bandaged
  • The stent helps to not only strengthen the arterial wall, but also prevent its rupture

Where is the Procedure Performed?

An Aneurysm Repair procedure is performed in a hospital. The patient gets admitted, undergoes the procedure, and is discharged as per the instruction of the physician. 

Who Performs the Procedure?

The surgery is generally performed by a vascular or a cardiovascular surgeon assisted by an anesthesiologist, a radiologist, and a pathologist.

How long will the Procedure take?

The procedure may take anywhere between 2 to 4 hours.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

  • Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
  • If you are allergic to any specific medication or food items
  • If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
  • If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
  • If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
  • If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
  • If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
  • A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

  • The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
  • Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
  • Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
  • Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
  • It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
  • Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
  • The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
  • For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

A physician will request your consent for the Aneurysm Repair procedure using an informed Consent Form.

What is the Consent Process before the Procedure?

A physician will request your consent for the Aneurysm Repair procedure using an informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Aneurysm Repair surgical procedure?

Prior to an Aneurysm Repair the physician may recommend any of the following tests:

  • Angiography
  • CT Scan or X-ray
  • Magnetic Resonance Angiography (MRA)
  • Duplex ultrasound
  • Routine blood test

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

  • What is the cause for an aneurysm?
  • How often should I screen for aneurysm? (in case the aneurysm detected, is still small)
  • Can the aneurysm subside with medication?
  • What is an Aneurysm Repair?
  • Why is this procedure necessary? How will this procedure help?
  • What does the procedure involve?
  • How soon should I get it done? Is there an emergency?
  • What are the alternatives to Aneurysm Repair surgery?
  • What are the risks involved?
  • Is there a possibility for the surgery to fail?
  • Would the surgery ensure that I would not get an aneurysm again?
  • Are there any specialists, or is there a particular hospital for the treatment, that you would recommend?
  • How long will it take to recover? When can I resume normal work?
  • Are there any lifestyle restrictions or modifications required, after the procedure is performed?
  • Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
  • Is there any medication that needs to be taken for life, after the procedure?
  • What are the costs involved?

During the Aneurysm Repair surgical procedure:

What kind of Anesthesia is given, during the Procedure?

General anesthesia is administered during the procedure.

How much Blood will you lose, during the Procedure?

  • The amount of blood loss is generally controlled and depends on the type of procedure adopted
  • However, in the case of an Endovascular Aneurysm Repair, the blood loss is minimal than compared to an Open Aneurysm Repair

What are the possible Risks and Complications during the Aneurysm Repair surgical procedure?

Some of the possible risks and complications that may arise during an Open Aneurysm Repair or an Endovascular Repair are:

  • Excessive bleeding
  • Stroke
  • Surgical wound infection
  • Blood clots that may escape into the blood stream
  • Rupture of the aneurysm

The complication and risks that may arise during the surgery is generally governed by the body part, where the aneurysm is located and state of the aneurysm.

What Post-Operative Care is needed at the Healthcare Facility after the Aneurysm Repair surgical procedure?

  • In normal cases there is no particular post-operative care required at the healthcare facility unless any complications are observed
  • However, if the aneurysm is located in and around a vital organ, like the heart or cerebrum; then, the healthcare facility must have an attached intensive care unit (ICU), for immediate post-operative care and recovery, if needed

After the Aneurysm Repair surgical procedure:

What are the possible Risks and Complications after the Aneurysm Repair surgical procedure?

The possible risks and complications that may arise after an Aneurysm Repair surgery is based on the location (body part) and type of aneurysm treated/removed.

What is the Prognosis after the Surgery?

  • The outcome of a successful Open Repair is usually good
  • Endovascular Aneurysm Repair however, is observed to have a lesser operative and post-operative mortality rate with faster recovery, as compared to Open Surgery
  • The post-operative mortality rate increases with age (beyond 65 years)

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

  • If you observe a lump in your body, irrespective of the absence (or presence thereof) of pain or throbbing at the location, inform your physician immediately
  • Pain, swelling, and fluid discharge from incision site
  • Occurrence of any symptom causing uneasiness like nausea, vomiting, dizziness

What Post-Operative Care is needed at Home after the Aneurysm Repair surgical procedure?

At home, the following post-operative care is recommended, after an Aneurysm Repair procedure:

  • Avoid any strenuous activity
  • Avoid water or soap on the surgical wound
  • Always keep the surgical wound clean and dry
  • Move your legs around and keep them elevated while resting, in order to decrease the possibility of blood clot formation in the leg
  • Take stool softeners to prevent constipation
  • Take medications to keep blood pressure under control
  • Complete the course of medication; avoid any non-prescription pain medication
  • Avoid sex till complete healing has taken place (under advise by the physician)

How long does it normally take to fully recover, from the Procedure?

It may take anywhere between 2 to 6 weeks for a complete recovery. However, if the aneurysm was treated or removed from around a vital organ or a region surrounding the organ, the recovery time could increase up to 6 months.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue (blood vessel) is taken for further examination and later disposed, as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

  • The tissue removed is processed in the laboratory under a pathologist's supervision
  • Slide(s) are prepared once the tissue is processed and this is examined by a pathologist and a pathology report issued
  • Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Aneurysm Repair surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers. 

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

  • the outpatient facility or the hospital
  • the surgeon
  • a radiologist (if radiological tests were performed during the procedure)
  • an anesthesiologist (if anesthesia was administered)
  • a pathologist (if the tissue was sent for analysis)

The patient is advised to inquire and confirm the type of billing, before Aneurysm Repair procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: May 20, 2013
Last updated: March 3, 2019