Endovascular Repair of an Abdominal Aortic Aneurysm

What is endovascular repair of an abdominal aortic aneurysm?

Endovascular repair is a type of treatment for an abdominal aortic aneurysm (AAA). An AAA is a bulge in the wall of the large artery below your heart. The large artery is called the aorta. The bulge is caused by a weak section in the artery wall. The bulge is at risk of tearing. During the procedure, the weak section of the aorta is treated to prevent it from tearing.

Your arteries are the blood vessels that send oxygen-rich blood and nutrients to the tissues of your body. The aorta is the largest artery in the body. It leads from your heart down through the inside of your chest and belly (abdomen). The section that goes through the abdomen is called the abdominal aorta. The walls of your aorta are normally thick enough to handle the force of the blood pressure from the heart. But some health problems can damage the walls of the aorta. This can cause a balloon-like bulge in the wall of the aorta called an aneurysm. In some cases, an aneurysm can start to split or even burst. This can often cause death. An aneurysm may also start to split along the inside of the aorta wall. This is known as aortic dissection. It can also often cause death.

Many factors can damage the walls of your aorta and cause an aortic aneurysm, such as:

• High blood pressure

• Smoking

• Atherosclerosis

• Injury

• Some infections, such as untreated syphilis

• Some genetic conditions, such as Marfan syndrome

• Aging

Endovascular repair is a minimally invasive procedure. This means it's done with a small cut (incision). It's often done under general anesthesia, so you sleep through the procedure. During the procedure, a surgeon makes an incision through an artery in your groin. A thin, flexible tube (catheter) is threaded up through the artery and to the site of the aortic aneurysm. A stent graft is sent along the catheter to the aneurysm. The stent graft is a tube made of a thin metal mesh (the stent), covered with a thin polyester fabric (the graft). This stent graft is opened inside the aorta and fastened in place. The stent graft stays in place, and blood flows through it. It protects that part of the aorta, and prevents the aneurysm from bursting.

Why might I need endovascular repair of an abdominal aortic aneurysm?

You may need this procedure if your AAA is over 5 centimeters (cm) or getting larger. You may also need this procedure if your AAA is at risk of splitting or bursting.

A small abdominal aortic aneurysm may not need a medical procedure. This is the case if an aneurysm is less than 5 cm and isn’t getting larger. A smaller aneurysm is less likely to burst or split. Your healthcare provider will closely watch your health and give medicines to lower the risk of aneurysm rupture.

Open surgery and endovascular repair are the 2 main types of surgery to repair an aneurysm. During open surgery, a surgeon makes a large cut in your belly or chest. The surgeon then replaces the damaged part of the aorta with a graft.

Endovascular repair uses a much smaller incision than open surgery. Because of this, it has a lower risk of complications. It may benefit older adults who have a higher risk of complications. It can also lead to faster recovery. Not all aneurysms can be treated with endovascular repair. Your provider will talk with you about the treatment that will work best for you.

What are the risks of endovascular repair of an abdominal aortic aneurysm?

Every procedure has some risks. The risks of this procedure include:

• Heavy bleeding at the insertion site

• Blood that still flows through the aneurysm bulge

• A graft that moves, bends, or comes loose

• Infection

• Heart attack

• Stroke

• Reaction to anesthesia

• Reduced blood flow to the legs, intestines, or kidneys

• Pressure in the abdomen that can damage organs (abdominal compartment syndrome)

• The need to change to open surgery during the procedure

• Death

Your risks may vary depending on your age, your overall health, and the size and location of your aneurysm. Talk with your healthcare provider to learn which risks apply to you. Talk with your provider about any questions or concerns you have.

How do I get ready for an endovascular repair of an abdominal aortic aneurysm?

Talk with your healthcare provider about how to prepare for your surgery. Before your procedure:

• Your healthcare provider will explain the procedure to you. Ask any questions you may have.

• You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if anything is not clear.

• Tell your provider about all the medicines you take. This includes over-the-counter medicines such as aspirin and all prescription medicines. It also includes herbs, vitamins, and other supplements. You may need to stop taking some medicines before the surgery, such as blood thinners.

• If you smoke, you will need to stop before your surgery. Smoking can delay healing. Talk with your provider if you need help to stop smoking.

• Let your provider know if you have ever had a problem with sedation or anesthesia.

• Tell your provider if you have allergies.

• Tell your provider if you are pregnant or think you might be pregnant.

• Follow any directions you are given for not eating or drinking before surgery.

• Tell your provider about any recent changes in your health, such as a fever.

You may need some tests before your procedure, such as:

• Blood tests. These can check for anemia and infection.

• Electrocardiogram (ECG). This is done to check your heart rhythm.

• Echocardiography. This can look at the size of your aneurysm.

• CT scan. This creates detailed X-ray images of your aneurysm.

• Angiography. This provides more detail about your aneurysm.

Follow any other instructions from your provider.

What happens during an endovascular repair of an abdominal aortic aneurysm?

A vascular surgeon and a team of specialized healthcare providers will perform the procedure. Your provider can explain what to expect for your surgery. This is an example of how it is done:

1. You will likely be given general anesthesia. This prevents pain and causes you to sleep through the procedure.

2. A healthcare provider will carefully monitor your vital signs, like your heart rate and blood pressure, during the procedure.

3. Your surgeon will make a small cut in your groin and into an artery there. Your surgeon will then insert a thin, flexible tube (catheter) into the artery.

4. The tube will be gently guided all the way to the site of the aneurysm. The surgeon will use moving X-ray pictures to get to the right spot.

5. A stent graft is sent along the catheter to the aneurysm. The stent graft is a tube made of a thin metal mesh (the stent), covered with a thin polyester fabric (the graft). The tube is collapsed so it is narrow and can fit through your blood vessel.

6. When the stent graft reaches the aorta, it is opened up and fastened in place. The stent graft then stays in place, and blood flows through it. It protects that part of the aorta, and prevents the aneurysm from bursting.

7. Your surgeon will remove the catheter. The incision in your groin is closed and a small bandage is put on the wound.

What happens after an endovascular repair of an abdominal aortic aneurysm?

After the procedure, you will spend several hours in the post anesthesia care unit (PACU). Your healthcare team will watch your vital signs, such as your heart rate, blood pressure, and breathing. To help prevent bleeding, you may need to lie flat for several hours after the procedure. You may need to stay at the hospital for a day or more, depending on your condition. Your healthcare provider will tell you more about what to expect.

You may have some pain after the procedure. You can take pain medicine as advised by your provider. You can eat a normal diet as soon as you are able.

You may need to take it easy for a little while after you get home. Ask your provider if you need to limit your activities and for how long. You may need to take medicines to help prevent blood clots. Follow all your provider’s instructions about follow-up care. This will help you have a better recovery.

Call your healthcare provider right away if you have any of these:

• Bleeding from the incision site that won’t stop with firm pressure

• Pain at the incision site that gets worse

• Increased bruising at the incision site

• Swelling, warmth or redness at the incision site

• Discharge from the incision site

• The limb with the puncture becomes weak, numb, or tingles, or feels cold or changes color

• Pain in your belly

Call 911 right away if any of these happen:

• The puncture site swells up very fast

• Bleeding from the puncture site does not slow down when you press on it firmly.

• Chest pain or shortness of breath

• Sudden severe pain in the belly, back, flank, or groin

Make sure to keep all follow-up appointments. You may need regular imaging tests of your aneurysm after the procedure. This is to help make sure the stent is still in place. Over time, the bulge of your aorta should start to shrink.

Work with your provider to help keep your blood vessels healthy and prevent a new aneurysm. Healthy lifestyle changes may include quitting smoking, exercising regularly, and taking medicines to lower your blood pressure and cholesterol.

Next steps

Before you agree to the test or the procedure make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how you will get the results

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure