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Patient Information -
Traditional (OPEN) Aortic Aneurysm Surgery at Queens Medical
Centre, Nottingham
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1. Why do I need the operation?
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| The main artery (aorta) in your tummy
(abdomen) has stretched and weakened (aneurysm). It has
grown to a size that means it may burst. If an aortic aneurysm
bursts, 9 out of 10 people die. You have been advised to have
your aneurysm repaired sothat it will not
burst (rupture). |
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2. What happens to me?
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| You will usually be admitted into the QMC the day before your operation.
Before this, you will be asked to
attend a pre-admission clinic about a week earlier to meet some
of the staff who will look after you and for them to explain
what will happen to you. At this meeting, Mr Braithwaite or one
of his team will review the tests that you have had. These may include scans of the abdomen.,
special scans of your heart and tests on how your lungs and
kidneys are working. If you have not done so already, you will be
asked to sign a consent
form. |
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3. Coming into hospital.
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| Please bring with you all the medications that you
are currently taking. You will be admitted to your bed by
one of the nurses who will also note down your personal details
in your nursing records. Prior to surgery you will undergo
a number of investigations, if these have not been performed
previously, including a heart tracing, a chest x-ray and blood
tests. You will be visited by the Surgeon who will be
performing your operation and also the doctor who will give you
the anaesthetic. If you have any questions regarding the
operation please ask the doctors. If you have not done so
already, you will be asked to sign a consent
form. |
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4. The operation.
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| The night before the operation, Mr Braithwaite may
ask one of the team to put a drip up as you will not be allowed
to eat or drink anything for 6 hours before the operation. This
is to stop you from being sick during your anaesthetic. On the
day of the operation, Mr Braithwaite advises that you have a
bath or shower. The surgical team will check that there is an intensive care or
high dependency unit bed available for you. Unfortunately, in
about 1 in 5 cases, a bed is not available and your operation
may have to be postponed.
If you have been given a drip the night before the operation,
this can be disconnected to let you wash. You will be taken initially to a reception area in
the theatre suite, then to the anaesthetic room where you
will be given your anaesthetic, and from there into the theatre.
As well as being put to sleep you may have a small tube
placed in your back (epidural) to help with pain relief
following surgery. If you are having an endovascular
aneurysm repair, you may not be put to sleep.
Whilst you are asleep tubes will be inserted into your
bladder to drain your urine, into your stomach (via your
nose) to stop you feeling sick, and into a vein in your neck for
blood pressure measurements and administration of fluid
following surgery. There will also be a small tube into your
wrist to accurately monitor you blood pressure. You will have a cut down or across your
abdomen and occasionally it is necessary to make a smaller cut
in one or both groins. The aorta and particularly the swollen
area will be replaced by an artificial blood vessel made of
plastic (Polyester or Dacron). During your operation, we will
try to save and replace most of the blood that is spilt using a
technique called cell salvage. The wounds will be stitched
with a suture (thread) under
the skin that dissolves by itself, or by clips that will need to be removed.
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5. After the operation.
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| You will usually be taken to an intensive care or
high dependency unit following your operation in order to
be able to monitor your progress closely. It is sometimes
necessary for you to remain on a breathing machine for a
period after the operation but you will be taken off this as
soon as possible. Following this sort of surgery the bowel
stops working for a while and you will be given all the fluids
you require in a drip until your bowel will cope with fluids by
mouth. A blood transfusion may also be required. The nurses
and doctors will try and keep you free of pain by giving pain killers
by injection, via a tube in your back, or by a machine that you
are able to control yourself by pressing a button (PCA). As the
days pass, and you improve the various tubes will be removed and
you will be returned to the normal ward until you are fit
enough to go home. You will be visited by the physiotherapist
before and after your operation who will help you with your
breathing to prevent you developing a chest infection and with
your walking. It is very important that you take deep breaths
after your operation so that your lungs are fully inflated. You
should also aim to be walking after 2 or 3 days. |
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6. Going home.
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Most people go home between 7 days and 14 days
after their operation. If dissolvable stitches have been used, these do
not need to be removed. If your stitches or clips are the
type that need removing, and this is not done whilst you are
still in hospital, the practice or district nurse will
remove them and check your wound. You will feel tired for many
weeks after the operation but this should gradually
improve as time goes by. Regular exercise such as a short walk
combined with rest is recommended for the first few weeks
following surgery followed by a gradual return to your
normal activity.
Driving: You will be safe to drive
when you are able to perform an emergency stop. This will normally
be at least 4 weeks after surgery, but if in doubt check with
your own doctor.
Bathing: You
may bathe or shower as normal.
Work: You should be able to return
to work within 1-3 months following your operation. If in doubt
please ask your doctor.
Lifting: You should avoid heavy
lifting or straining for 6 weeks after the operation.
You will usually be sent home on a small dose of aspirin if you
were not already taking it. This is to make the blood less
sticky. If you are unable to tolerate aspirin an alternative
drug may be prescribed. |
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7. Complications.
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| Chest infections can occur following this type of
surgery, particularly in smokers, and may require
treatment with antibiotics and physiotherapy. Slight discomfort
and twinges of pain in your wound are normal for several weeks
following surgery, but wounds sometimes become infected and
these can usually be successfully be treated with antibiotics.
Also the wound in your groin, if you have one, can fill with a fluid called lymph
that may discharge between the stitches. This usually
settles down with time. As with any major operation such as this
there is a very small risk of you having a medical complication
such as a heart attack, but the doctors and nurses will try to
prevent these complications and to deal with them rapidly
if they occur. Occasionally the bowel is slow to start working
again but this requires patience and fluids will be provided
in a drip until your bowels get back to normal. Sexual activity
may be affected due to nerves in your tummy being cut during the
operation. Mr Braithwaite tries to avoid nerve damage whenever
possible.
Some Aneurysms are filled with material like porridge called
thrombus. Very rarely, some of this thrombus can be dislodged
and can block arteries in the leg (embolus). If this happens,
the surgical team will try and remove the embolus. In extreme
circumstances, the blood supply to the leg is ruined and an
amputation may be required.
Complications are uncommon but they must be balanced with the
90% risk of dying if your aneurysm bursts.
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8. What can I do to help myself?
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| If you were previously a smoker you must make a
sincere and determined effort to stop completely. Continued
smoking will cause further damage to your arteries and your
graft is more likely to stop working. General health
measures such as reducing weight, a low fat diet and regular
exercise are also important. |
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Related Links:
Abdominal
Aortic Aneurysms
Axillobifemoral,
Aortobifemoral grafts
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