Endovascular Stent Graft Repair of Abdominal Aortic Aneurysm

What is an abdominal aortic aneurysm?
An abdominal aortic aneurysm (AAA) is an abnormal widening of the aorta. The aorta is the main artery of the body. It arises from the heart and travels down through the chest into the abdomen. The normal size of the aorta measures about 2.3 cm (1 inch) in men and 1.9 cm (3/4 inch) in women, however this varies with body size and age. When the aorta is dilated to more than 1.5 times its normal diameter it is called an aneurysm.

What are the signs and symptoms of an abdominal aortic aneurysm?
Most aneurysms cause no symptoms at the time they are diagnosed. Abdominal aneurysms are usually found either on routine physical exam of the abdomen or incidentally by an abdominal ultrasound or CT scan performed for some other reason.  A specially performed CT scan and angiogram will help define the anatomy of the aneurysm and determine if you are a candidate for stent graft repair of your aneurysm.
An aneurysm is a concern because of the risk that it may rupture. A leaking or ruptured aneurysm may cause the sudden onset of severe abdominal or back pain, a pulsating abdominal mass, and low blood pressure and shock resulting in dizziness, fainting, sweating, a rapid heart beat, and sudden weakness.

What is Endovascular Stent Graft Repair of AAA?
Endovascular stent grafting is a procedure in which a stent graft (a tube composed of a synthetic fiber covered by a wire mesh) is placed inside of the aneurysm. The stent graft prevents rupture of the aneurysm. Fewer than 50% of patients with abdominal aneurysms are candidates for stent graft repair. Specific criteria regarding the configuration of the aorta and aneurysm will determine if you are a candidate for a stent graft repair.
This procedure is performed in the operating room. A small incision is made in each groin. A catheter (a thin flexible tube) containing the vascular graft is guided up through a blood vessel in your groin to the aorta. The vascular graft is anchored in the aorta above the origin of the aneurysm. The catheter is then removed leaving behind the graft and the groin incisions are closed. Rarely, your surgeon may have difficulty placing the graft. If this happens he may need to convert to the traditional open operation.

What happens after my aneurysm is repaired?
You will spend the first night after the procedure on the step down unit.
You will be encouraged to get out of bed and walk in the hallways.
Your regular diet will be resumed.

Before Your Procedure
  • Please be sure to complete all necessary testing 7 to 10 days prior to your procedure.
  • Please have clear liquids for dinner the evening prior to your procedure. (jello/soup broth)
  • Please use the dulcolax suppository the evening prior to your procedure.
  • Do not eat or drink anything after midnight prior to your procedure.
  • If you are taking coumadin or plavix please stop 3 days before your surgery.
  • It is not necessary to stop your aspirin.

Diabetics: reduce your evening dose by 1/2 the evening prior to surgery and take no insulin the morning of your procedure.

You may take your usual morning medicines with a sip of water.

Going Home

Care of the Surgical Incisions
Incisions are made in each groin to allow for placement of the stent graft. These incisions are closed with sutures/staples. Some areas may be closed with steri strips; pieces of paper tape.
Most patients are able to go home on the 2nd day after the procedure.

Bathing
You may shower 72 hours following the procedure. Let the water gently run over the incisions and pat dry with a clean towel. Leave the incisions uncovered. Do no tub bathe for one week following the procedure.

Fever
You may experience a low-grade fever 7 to 10 days following the placement of the endovascular stent.

Activity
You may feel tired for a few days following the procedure. Most patients find themselves back to their normal activity level in two weeks. You may resume driving after 7 days if you feel well enough and are not taking narcotic pain medication.

Preventative Antibiotics
Please let your dentist and primary care physician know you have a stent graft in place. A preventive dose of antibiotics prior to dental work and other invasive procedures is recommended to prevent the graft from potentially becoming infected.

When to Notify the Surgeon’s Office
Call our office if you have:
– Prolonged fever higher than 101 degrees F or 39 degrees Celsius.
– Redness, increased swelling, tenderness, or drainage of pus from the groin incisions.
– Severe or unusual leg pain, numbness, coldness, or weakness.
– Severe or unusual abdominal or back pain.

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