Name of the Procedure:

Symptomatic Abdominal Aortic Aneurysm (AAA) Repair

Summary

This procedure involves surgically repairing an enlarged area in the lower part of the major blood vessel that supplies blood to the body (the aorta). This condition, called an abdominal aortic aneurysm, can cause life-threatening bleeding if it bursts. The urgent/emergent repair is carried out quickly to prevent rupture and stabilize the patient.

Purpose

The procedure addresses:

• Abdominal aortic aneurysms that are symptomatic and at risk of rupture.
• The main goal is to prevent aneurysm rupture, reduce immediate life-threats, and restore normal blood flow.

Indications

• Sudden, severe abdominal or back pain.
• Symptoms like a rapid heart rate, dizziness, or fainting.
• Evidence of aneurysm expansion or leakage.
• Patients with confirmed diagnosis of a symptomatic AAA and deemed at high risk of rupture.

Preparation

• Patients may need to fast for several hours before surgery.
• Blood tests, imaging tests (CT scan, MRI, ultrasound), and other diagnostics are required.
• Medication adjustments may be necessary, particularly for blood thinners.

Procedure Description

1. Anesthesia: General anesthesia is administered to keep the patient pain-free and unconscious.
2. Incision: A long incision is made in the abdomen (open surgery) or multiple small incisions for an endovascular repair.
3. Repair: The surgeon places a graft to reinforce the affected part of the aorta and redirect blood flow.
4. Closure: Incisions are closed with sutures or staples, and sterile bandages are applied.
5. Monitoring: Continuous monitoring during recovery to ensure stability.

Duration

• Typically takes 2 to 6 hours, depending on the complexity and approach (open vs. endovascular).

Setting

• Performed in a hospital operating room, requiring advanced surgical facilities and immediate post-operative care units.

Personnel

• Cardiovascular or vascular surgeon.
• Anesthesiologist.
• Surgical nurses and techs.
• Post-operative care team.

Risks and Complications

• Common risks: Bleeding, infection, blood clots.
• Rare risks: Graft failure, renal failure, heart attack, stroke.
• Complication management includes monitoring, medications, or additional surgical tools.

Benefits

• Prevention of aneurysm rupture.
• Improved survival rates.
• Stabilization of the patient's health.
• Benefits are typically realized almost immediately, especially in an emergent context.

Recovery

• Hospital stay for 5-10 days, with initial intensive care.
• Gradual return to normal activities over 4-8 weeks.
• Follow-up appointments for imaging and assessments.
• Instructions include activity restrictions and wound care.

Alternatives

• Watchful waiting with regular monitoring (for less severe cases).
• Endovascular aneurysm repair (less invasive alternative but may not be suitable for all patients).
• Medication management to control underlying conditions like hypertension.
• Each alternative has its own pros and cons, such as lower immediate risk but potentially higher long-term risk.

Patient Experience

• Initial discomfort, managed by pain relievers.
• Possible side effects from anesthesia (nausea, confusion).
• Gradual improvement in symptoms as healing occurs.
• Support from medical staff to ensure comfort and proper recovery throughout the hospital stay and beyond.