Abdominal Aortic Aneurysm, Endograft Repair

The aorta is a large blood vessel that carries blood from the heart to the rest of the body. An abdominal aortic aneurysm (AAA) is a weakness in the wall of the aorta and can cause the aorta to balloon or bulge out. If the aneurysm becomes too big, it can burst and be fatal.

An endograft is a special aortic stent graft used to repair the AAA. It is a tube made up of fabric, which is supported by a metal mesh (stent). It prevents the aneurysm from rupturing. The endograft creates a new track for the blood to flow inside the aorta, diverting it from the aneurysm. The stent is permanent.

SYMPTOMS

  • May be absent.

  • Pain in the abdomen, chest or back. This may be a "throbbing," "aching" or "tearing" feeling.

  • A lump or mass in the abdomen that pulses.

  • Cold foot or blue toes.

  • Severe pain and collapse if the aneurysm bursts.

RISK FACTORS

  • Family history of AAA.

  • Smoking.

  • High blood pressure.

  • High levels of fat (cholesterol) in the blood that cling to the wall of the aorta.

  • "Hardening of the arteries" (arteriosclerosis).

  • Heart disease.

  • Diabetes.

TREATMENT

  • When the aneurysm is small, it will be watched closely.

  • The size is followed once or twice a year with an imaging study, such as an ultrasound.

  • Making lifestyle changes, such as quitting smoking and changing what you eat, are very important.

  • Your caregiver may have you take medicine to help reduce blood pressure and high cholesterol.

  • An aneurysm can be repaired in 1 of 2 ways:

  • Placement of an endograft through small cuts in your upper thigh (groin).

  • Major surgery to repair the aneurysm.

LET YOUR CAREGIVER KNOW ABOUT:

  • Allergies.

  • Medicines taken including herbs, eye drops, prescription medicines (especially medicines used to "thin the blood"), aspirin and other over-the-counter medicines, and steroids (by mouth or as a cream).

  • History of blood clots in your legs and/or lungs.

  • Previous problems with anesthetics or medicines used to numb the skin.

  • History of bleeding or blood problems.

  • Previous surgery.

  • Possibility of pregnancy, if this applies.

  • Any other important health problems.

RISKS AND COMPLICATIONS

  • Leaking of blood around the endograft.

  • Infection.

  • Displacement of the endograft away from the effective location.

  • A block in the flow of blood through the graft. In rare cases, this can cause a block of blood flow to the legs.

  • Possible blood clots.

  • Kidney problems may occur in some people.

  • Exposure to X-rays and radiation.

  • Rare rupture of the aorta even after successful endograft repair.

  • Possible surgical repair of the aneurysm.

BEFORE THE PROCEDURE

  • Your caregiver will explain the risks and benefits of endograph repair and answer your questions.

  • You may have a complete physical exam and tests to assess your general health.

  • Other tests are done to help determine the size and location of the AAA. This helps with choosing the correct size and shape of the endograph.

  • You may be asked to stop taking certain medicines (particularly medicines that "thin the blood") before the procedure.

  • You will be asked to not eat or drink anything beginning at midnight before the procedure. You may be told to take your regular medicines with a little water on the morning of the procedure. These instructions may vary if the procedure takes place in the afternoon.

PROCEDURE

  • The groin area will be washed and shaved.

  • Small cuts (incisions) are usually made on both sides of your groin. Long, thin tubes (catheters) are passed through these incisions into your leg artery and up into the aneurysm.

  • Live X-ray pictures are used to guide the endograft through the catheter to the site of aneurysm.

  • The endograft is released to seal off the aneurysm and line the aorta.

  • X-rays will check the position of the endograft and confirm placement.

  • The catheters are taken out, and the incisions are closed with a few stitches.

  • The procedure may take 1 to 3 hours.

AFTER THE PROCEDURE

  • You will need to lie flat for several hours. Bending the leg that has the insertion site can cause it to bleed and swell.

  • You may need to stay in the hospital for a few days.

  • You will need follow-up visits to assess the repair.

  • Certain tests may be done to check the function and location of the endograph after your procedure.

HOME CARE INSTRUCTIONS

  • Follow all the instructions given by your caregiver.

  • Check your incisions for signs of infection.

  • Keep your appointments.

  • Limit your activities as directed.

  • Be sure you know how and when to take your medicines.

  • Make lifestyle changes to improve your health and quality of life.

SEEK MEDICAL CARE IF:

  • You develop abdominal, chest or back pain.

  • You have an oral temperature above 102° F (38.9° C).

  • It is hard to breathe.

  • There is increased swelling around your groin site.

  • There is a leak of fluid/blood from the groin site.

SEEK IMMEDIATE MEDICAL CARE IF:

  • There is a sudden increase in swelling or bleeding around your groin site. This is a medical emergency.

  • There is a sudden onset of pain in your legs and/or difficulty in moving either of your legs.

  • You notice a red streak starting at the groin site and extending above or below that site.

  • You have an oral temperature above 102° F (38.9° C), not controlled by medicine.

MAKE SURE YOU:

  • Understand these instructions.

  • Will watch your condition.

  • Will get help right away if you are not doing well or get worse.