Name of the Procedure:

Repair of Thoracoabdominal Aortic Aneurysm with Graft

• Common Names: Aneurysm Repair, TAAA Repair
• Medical Terms: Thoracoabdominal Aortic Aneurysm (TAAA) Repair

Summary

A repair of a thoracoabdominal aortic aneurysm involves surgically correcting a weakened or bulging section of the aorta (the large artery that runs from the chest to the abdomen) with a synthetic graft. This procedure may or may not utilize cardiopulmonary bypass, a technique that temporarily takes over the function of the heart and lungs during surgery.

Purpose

The procedure aims to:

• Prevent rupture of the aneurysm, which can be life-threatening.
• Restore normal blood flow through the aorta.
• Alleviate symptoms caused by the aneurysm pressing on surrounding tissues.

Indications

This procedure is indicated for:

• Large aneurysms (typically over 5-5.5 cm in diameter).
• Rapidly expanding aneurysms.
• Symptomatic aneurysms causing pain or pressure symptoms.
• Aneurysms at risk of rupture based on their size and growth rate.

Preparation

• Patients may be instructed to fast for at least 8 hours before surgery.
• Certain medications, particularly blood thinners, might need to be adjusted or stopped.
• Preoperative testing may include blood tests, imaging studies (like CT or MRI scans), and cardiac evaluations.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is fully asleep and pain-free during the procedure.
2. Incision: A large incision is made in the chest and/or abdomen to access the aneurysm.
3. Aneurysm Isolation: The blood flow is temporarily rerouted or controlled.
4. Graft Placement: The affected section of the aorta is replaced with a synthetic graft.
   • Tools: Surgical instruments, synthetic graft, possibly cardiopulmonary bypass machine.
5. Closing: The incision is closed with sutures or staples, and dressings are applied.

Duration

The procedure typically takes 4 to 8 hours, depending on the complexity of the aneurysm and whether cardiopulmonary bypass is used.

Setting

The procedure is performed in a hospital, specifically in an operating room equipped for major vascular surgeries.

Personnel

• Cardiovascular Surgeons
• Anesthesiologists
• Surgical Nurses
• Perfusionists (if cardiopulmonary bypass is used)

Risks and Complications

• Common Risks: Infection, bleeding, lung complications, heart complications.
• Rare Risks: Organ damage, nerve injury, graft failure, stroke.
• Management of Complications: May require additional medications, procedures, or surgeries.

Benefits

• Reduces the risk of aneurysm rupture.
• Improves quality of life by alleviating symptoms.
• Most benefits are realized immediately after recovery from surgery.

Recovery

• Hospital Stay: Typically 7-10 days post-surgery.
• Instructions: Avoid heavy lifting, follow-up imaging, wound care.
• Full Recovery: Usually takes several weeks to a few months.
• Follow-up: Regular check-ups to monitor graft and overall health.

Alternatives

• Endovascular Aneurysm Repair (EVAR): Less invasive but not suitable for all aneurysm locations.
• Medical Management: Monitoring and managing risk factors if surgery is not immediately necessary.
• Pros and Cons: EVAR has a shorter recovery but might not be as durable as open surgical repair.

Patient Experience

• During Procedure: The patient will be under general anesthesia and will not feel any pain.
• After Procedure: Pain at the incision site managed with pain relief medications, some discomfort as the body heals.
• Pain management: Includes prescribed medications and possibly techniques like physical therapy to assist recovery.