Heart Hospital - Procedures
Abdominal Aortic Aneurysm (AAA) - Endovascular Graft

Why is the physician performing an endovascular graft?

The graft is performed to repair a weakened portion of the aorta located in the abdomen. The aorta is the largest artery in the body. It carries oxygen-rich blood from the heart to the rest of the body, including the abdomen. The weakened aorta, sometimes called an aneurysm, can balloon out, becoming thin, large and fragile. As it enlarges, there is risk of rupture with massive, internal bleeding.

What is the surgery?

The surgery is performed by an endovascular surgeon who may be assisted by an interventionalist (radiologist or cardiologist) and an anesthesia care provider. It is done in the operating room or specialized suite, and takes between three and six hours.

A traditional AAA repair is an open-abdomen repair. The bulging aneurysm part of the aorta is removed and replaced with an artificial graft. The remaining aortic end-pieces are reattached to the graft.

A less invasive surgery called an endovascular repair of AAA involves placing a stent graft to stop blood flow to the aneurysm. The blood flow is through the stent, entirely bypassing the aneurysm. This prevents rupture and excludes the aneurysm from circulation. This less invasive method allows patients who may not be candidates for open surgery to have their aneurysm repaired.

Preoperative Preparation

The physician and the patient, along with family members have a discussion regarding:

• Repair procedure
• Advantages and disadvantages of alternative procedures available
• Advantages and disadvantages of the endovascular approach
• Risks
• Possible complications
• Lifetime commitment for imaging surveillance to assess for possible graft rupture

Following the discussion, the physician obtains informed consent from the patient for endovascular repair

Preoperative Tests Done in the Outpatient Setting

• Blood type and screen
• Lab tests
• Electrocardiogram (ECG)
• CT scan with 3D imaging

The surgeon orders a cardiac consultation if the patient has a history of myocardial infarction, angina, congestive heart failure, arrhythmias or heart murmurs, to determine the patient's fitness for surgery.

The Night Before Surgery

• Nothing by mouth after midnight
• Shower with antimicrobial soap to decrease bacterial skin count

The Day of Surgery

Upon arrival at the hospital the morning of surgery you are admitted to the preoperative holding area.

The preoperative nurse on the nursing unit:

• Assesses your health status
• Verifies completeness of informed consent
• Places an IV (intravenous) and starts IV fluids
• Prepares the surgical site
• Administers preoperative antibiotics, if ordered
• Instructs you regarding what to expect postoperatively
• Demonstrates the use of the incentive spirometer with coughing and deep breathing

The anesthesia care provider interviews you and discusses the anesthesia option which has been selected.

Preparation in Operating Room

The circulating nurse reviews:

• Your medical record for any other existing medical conditions that could affect the intraoperative period
• Blood availability
• History and physical examination
• Laboratory values
• Presence of allergies
• Required preoperative antibiotics
• Overall chart completeness
• Signed informed consent for surgery

The nurse then identifies the patient verbally and via the wrist identification band, verifies nothing by mouth status, presence of any implanted devices and any limitations in movement or skin integrity. He or she also educates you regarding the operation.

Postoperative Care

Your stay in the postanesthesia care unit (PACU) is dependent on the type of anesthesia administered and your condition. The PACU nurse monitors:

• Respiratory status
• Oxygen saturation
• Arterial and systemic blood pressures
• Electrocardiogram status
• Intake and output
• Surgical incisions for bleeding
• Your pain status
• Sensation, movement, color, temperature and pulses in both lower extremities

When you are moved from PACU to cardiac intermediate care unit (C/IMCU) you will experience:

• Laboratory studies being done postoperative day one
• Encouragement to cough and deep breathe and use of the incentive spirometer at least every two hours
• Antibiotic administration
• Advancement from clear liquid diet to your usual diet
• Ambulation six to eight hours after surgery

If you have no complications, you may be discharged as early as the first postoperative day; however the usual length of stay is two to three days. You will need someone to stay with you for several days after your surgery, when you go home. Your doctor will discuss this with you.

More Information

For more information on a related topic, please read our Aneurysm article.

6/23/2008