Name of the Procedure:

Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm and associated occlusive disease, carotid, subclavian artery, by neck incision.

• Common Name: Carotid or Subclavian Artery Aneurysm Repair
• Technical Terms: Aneurysmectomy, Arterioplasty, Carotid Endarterectomy

Summary

This surgical procedure involves the direct repair or removal of an aneurysm (a bulging, weakened area in the artery wall) or pseudoaneurysm (a false aneurysm) in the carotid or subclavian artery. It often includes inserting a graft and can involve patch grafts. The surgery is done through an incision in the neck.

Purpose

The procedure is aimed at treating aneurysms or pseudoaneurysms in the carotid or subclavian artery to prevent rupture or other complications. It also addresses associated occlusive disease, which can impede blood flow. The goal is to restore normal blood flow and prevent life-threatening events like strokes or artery rupture.

Indications

• Presence of a diagnosed aneurysm or pseudoaneurysm in the carotid or subclavian artery
• Symptoms of occlusive disease such as dizziness, transient ischemic attacks, or stroke
• Patients with significant risk of artery rupture
• Criteria: Typically advised for patients who are otherwise healthy enough to undergo surgery and have a significant aneurysm or symptomatic occlusive disease.

Preparation

• Patients might need to fast (not eat or drink) for at least 8 hours before the procedure.
• Medication adjustments may be necessary, such as stopping blood thinners.
• Preoperative diagnostic tests, such as ultrasound, CT scan, or MRI, to assess the aneurysm.

Procedure Description

1. Anesthesia: General anesthesia is typically administered.
2. Incision: A surgical incision is made in the neck over the area of the aneurysm.
3. Excision/Repair: The aneurysm is either repaired directly or excised (removed). If excised, a graft (synthetic or vein) is used to reconstruct the artery.
4. Patch Graft: A patch graft may be used to reinforce the artery wall.
5. Closure: The incision is closed with sutures.

Duration

The procedure typically takes 2-4 hours, depending on the complexity.

Setting

Performed in a hospital operating room.

Personnel

• Vascular Surgeon
• Surgical Nurses
• Anesthesiologist
• Surgical Technicians

Risks and Complications

• Common risks: Infection, bleeding, bruising.
• Rare complications: Stroke, nerve damage, graft failure, blood clots.
• Management: Immediate medical attention and possible further surgical intervention if complications arise.

Benefits

• Prevents aneurysm rupture and associated severe complications.
• Restores normal blood flow.
• Reduces the risk of stroke.

Recovery

• Hospital stay: Usually 1-2 days.
• Postoperative care includes pain management, wound care, and monitoring for complications.
• Recovery time: Generally 4-6 weeks.
• Restrictions: Avoid heavy lifting and strenuous activities; regular follow-up appointments for monitoring.

Alternatives

• Endovascular repair: Less invasive but may not be suitable for all patients.
• Medical management: For smaller, asymptomatic aneurysms with regular monitoring.
• Pros and cons: Endovascular repair has a quicker recovery, but may not be as durable; medical management avoids surgery but carries risk of aneurysm growth or rupture.

Patient Experience

• During: The patient will be under general anesthesia and not feel anything.
• After: Pain and discomfort in the neck area, managed with medications. Possible sore throat due to breathing tube used during anesthesia. Gradual return to normal activities with full recovery in about 4-6 weeks.