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Date issued: December 2023

Review date: December 2025

Ref: A-594/JW/Vascular/Abdominal Aortic Aneurysm (AAA)

PDF:  Abdominal Aortic Aneurysm AAA.pdf [pdf] 234KB

What is an Aneurysm?

Aneurysms result from stretching of a weakened artery, which balloons out rather like a worn motorcar tyre. When this happens, there is a risk that the artery may burst. The most common artery to be affected is the aorta, which is the main artery in the tummy (abdomen).

What treatments do we have for aortic aneurysms?

Open operation:

This involves a vertical or horizontal incision in the abdomen and occasionally also in the groins. The aorta (which runs at the back of the abdomen) is clamped so that it can be opened up and a tube of fabric (usually Dacron) stitched inside it. Sometimes a tube with two ends like a pair of trousers is required to take blood to both legs. The tube allows blood flow to continue to the organs and the legs but stops blood flowing into the aneurysm so that it is no longer a risk. The operation requires a general anaesthetic (to send the patient to sleep) and often needs a 1-2 week stay in hospital.

Endovascular aneurysm repair:

In this operation, a fabric tube with a metal support (stent) is inserted into the aneurysm in a collapsed state inside a delivery tube, through two small incisions in the groins. The tube is then opened up after it has been placed inside the aneurysm. The tube stays in place by small hooks and fixes to the aneurysm wall as it expands. The operation which involves xrays can be done in theatres or in the x-ray department. It is often done under general anaesthetic but can be done with other forms of anaesthetic (epidural / spinal) and even under local anaesthetic. The operation usually requires a 2-4 day stay in hospital.

What happens after the operation?

The open operation is a major operation and inevitably the recovery is longer. You will usually be taken to the high dependency unit (HDU) or intensive care unit (ICU) for close monitoring, sometimes for several days. The recovery after an endovascular operation is generally much quicker and may only involve a few hours in HDU.

After your operation, you will be given fluids by a drip in one of your veins until you are well enough to sit up and take fluids and food by mouth. The nurses and doctors will try and keep you free of pain by giving pain killers by injection, via the epidural tube in your back, or by a machine that you are able to control yourself by pressing a button (PCA – patient controlled analgesia).

Within a day or so, the drip, epidural and bladder catheter will be removed. If you have had an open operation it takes a few days for your bowel to work properly and you will only be allowed small amounts of fluid for a few days before getting back to normal diet.

Potential Complications

Wound infection: (uncommon)

Graft infection: (very rare less than 1 in 100). If the graft does get infected, it often only becomes apparent several years later and is a very serious condition usually requiring further major surgery.

Heart attacks and Heart failure: (Possible) complications during and after any aortic surgery, especially if you have some degree of heart disease before the operation.

Chest infections: (Common) usually treatable with antibiotics but occasionally require a period of assisted ventilation in intensive care.

Kidney failure: (Possible). It is more common if there is kidney disease before the operation.

Stroke: (Rare) but we may perform a scan of the neck arteries before your operation to help us assess this risk.

Loss of blood supply to part of the bowel: (Very Rare) and the formation of a temporary (occasionally permanent) colostomy (a bag).

Deep vein thrombosis: (DVT): We try to prevent this by giving a daily injection under the skin before the operation and every day after until you are mobile again and by using squeezy stockings. Occasionally a clot can pass to the lung causing a pulmonary embolus (PE) which can be a serious condition but is usually treatable with anticoagulant medications.

Loss of blood supply to a leg: The aorta carries the blood supply to both legs and rarely clots or debris from inside the aneurysm can pass down into the leg(s). If this happens we will do everything we can to remove the clot but on very rare occasions the leg may not survive requiring amputation.

Impotence: The nerves that control the sexual organs run in front of the aorta. Problems with erection and ejaculation are not uncommon after the open operation (about 1 in 4)

Going Home

Your Dressing will usually be removed before discharge if you have any sutures or clips that need removing late this will either be done at your GP practice or by the district nurses if you are housebound.

Driving: You can drive when you can safely perform an emergency stop this is usually 4-6 weeks post surgery. If you have any concerns please contact your insurance company.

Bathing: When you wound is dry you can bathe and shower as normal

Work: You will be able to return to work 6-12 weeks post surgery. We will provide you with a sick note for this.

Exercise: You can resume regular exercise such as a short walk combined with rest for the first few weeks and then gradually return to normal activity.

Lifting: You should avoid heavy lifting or straining for 6 weeks.

Elevate your leg as much as possible to prevent swelling

Who to contact If I have any concerns?

Less than 24 hours post discharge:

Call 01752 202082 and ask for the ward you were discharged from.

After 24 hours post discharge:

Urgent Medical Help: 111 or 999

Pain/ medication concerns: GP

Operation specific questions: Consultant’s Secretary or Vascular Specialist Nurse

Consultant Vascular Surgeon and Lead Clinician

Mr Devender Mittapalli

Secretary: 01752 431822

Consultant Vascular and Transplant Surgeon

Mr Jamie Barwell

Secretary: 01752 431822

Consultant Vascular Surgeon

Surgeon Commander Cris Parry RN

Secretary: 01752 431822

Consultant Vascular Surgeon

Miss Catherine Western

Secretary: 01752 431805

Consultant Vascular Surgeon

Lt Col Robert Faulconer

Secretary: 01752 431805

Consultant Vascular Surgeon

Mr Hashem Barakat

Secretary: 01752 431822

Vascular Nurse Specialist

Mr Alan Elstone

Miss Jess Webster

01752 431805

What can I do to help myself?

• Quit Smoking

• Lower Cholesterol

• Keep active

• Control blood sugar levels in diabetes

• Maintain a healthy diet

• Maintain a healthy blood pressure

The nurse looking after you will be able to give you information/resources for any of these that are relevant to you.