|
Open abdominal or open chest surgery
The current standard treatment for repairing a thoracic or an abdominal aortic aneurysm is surgically removing the weak section of the aortic wall and replacing it with a tube made of Dacron as shown in this picture. The tube, also known as a graft, is spliced in and sewn in place with permanent suture material. Over time, the blood vessel's normal thin inner lining of cells grows over inside of the Dacron tube, making a durable conduit for blood flow. The operation to repair an aneurysm can be surgically complex, depending upon the location of the aneurysm.
|
|  |
|
Repairs along the ascending aorta are the most straightforward of thoracic aortic aneurysm repair procedures, with the surgeon using an incision in the front of the chest. During this open-heart procedure, the patient is placed on a cardiopulmonary bypass machine, which circulates oxygenated blood to the body while the surgeon replaces the diseased section of the aorta with a graft, as shown in this picture. In patients with a bicuspid aortic valve, a congenital defect of the valve between the heart and the aorta, the valve may also be repaired or replaced during the operation. Valve repair or replacement is recommended if the valve is leaking or narrowed, or the patient may elect to have the bicuspid valve replaced to avoid a second heart surgery in the future.
Aneurysms located along the aortic arch also require open heart surgery with the surgeon accessing the aneurysm from the front of the chest. However, aortic arch repairs involve disconnecting the arteries that supply blood to the brain from the diseased aortic arch and reattaching them to the graft, as shown in this picture. This procedure interrupts blood flow to the brain. In these operations, the patient is not only placed on cardiopulmonary bypass to take over the functions of the heart and lungs by pumping blood to the body but also undergoes hypothermic cooling.
Hypothermic cooling lowers the patient's internal body temperature to protect the brain while the arch is replaced. At 18 degrees centigrade (64.4 degrees Fahrenheit), blood flow to the brain can be interrupted for up to 30 minutes with no detectable effects on brain function. Recently, some surgeons have started using a specialized technique known as selective antegrade cerebral perfusion to circulate oxygenated blood into the brain during this procedure, which decreases the overall amount of time blood flow to the brain is interrupted.
If the aneurysm involves the descending thoracic aorta or the thoracic abdominal aorta, an incision on the left side of the chest will most likely be used. For this procedure, the cardiopulmonary bypass machine may not be necessary.
Abdominal aortic aneurysm repair does not require cardiopulmonary bypass. The surgeon typically uses an incision either in the abdomen or along the side or flank. Abdominal aortic aneurysm may also be repaired using less invasive endovascular surgery.
Recovery from open abdominal or chest surgery for aortic aneurysm repair varies depending upon the surgical procedure involved and the patient's overall health. Some people may need only one month and others may need two months of recovery time before returning to their daily routine after aneurysm surgery. Recovery starts in the hospital with the first few days routinely spent in the intensive care unit. Typically, patients spend a total of seven to 10 days in the hospital, depending upon the patient's condition and the operation performed.
When an aneurysm is repaired electively to avert rupture or dissection, the risk of death depends upon the location of the aneurysm, the overall health of the patient, and the skill of the surgeon. Risks can be as low as less than 1 percent for a repair of the ascending aorta performed by a skilled surgeon in an otherwise healthy individual. The risks increase slightly for repairs involving the aortic arch, are higher for repairs of the descending thoracic aorta, and are still higher for repairs of the abdominal aorta. The highest risks are associated with repairs of thoraco-abdominal aortic aneurysm, which can have up to a 10 percent risk of death. Thoraco-abdominal aneurysm repairs also have a 5 to 10 percent risk of paraplegia. Risks of surgery increase with the patient's age and presence of other health problems.
Other less severe complications of aneurysm repairs include wound infection, blood clots, bleeding, kidney failure, pneumonia, erectile dysfunction, and leakage around or behind an endovascular graft.
|
