Abdominal Aortic Aneurysm - Open AAA Repair Operation
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WHAT IS EVAR?
EVAR is a “keyhole” surgery technique where the aneurysm in your tummy is repaired using a special stent. In endovascular repair the aneurysm isn’t removed, a stent graft is fitted inside the aorta to strengthen it.
The following information will help explain the process of the EVAR surgery.
Before going into hospital you should consult your GP and consultant about the medications you are currently taking as it may be necessary to stop taking them before the operation
The Operation
The Anaesthetic
The first part of the operation involves giving you an anaesthetic so that you will be asleep during the operation. A tiny needle will be placed in the back of your hand. The anaesthetic is injected through the needle and you will be asleep within a few seconds. Next, you may have a small tube placed in your back (epidural) to help with pain relief after surgery.
A tube (catheter) will be inserted into your bladder to drain your urine. Additional drips will be placed into a vein in your neck and your wrist for blood pressure measurements and to give you some fluids during and following surgery.
Sometimes there will be a tube into your stomach (via your nose) to stop you from feeling sick.
The Open Operation
You will have a cut either down or across your stomach, and occasionally a smaller cut may be needed in one or both groins.
The enlarged segment of the aorta will be replaced by an artificial blood vessel (graft) made of Dacron. Sometimes this will be a simple tube, and sometimes, as in the illustration, a branching graft to each leg artery is used.
The redundant aneurysm sac is closed over the graft at the end of the procedure to separate it from the overlying structures.
The wounds are closed with either a stitch under the skin that dissolves or by clips that will need to be removed about 10 days after the surgery.
Recovery and Aftercare
You will normally be sent back to the ward where you will be monitored to make sure everything is alright.
After a few hours you will be given something to drink and later on may be given some food.
You should be allowed to get up and walk around the same evening and the following morning will have the tube taken out of your bladder.
An ultrasound scan will be carried out the following morning to make sure that the stent graft has sealed the aneurysm. You can expect to be allowed home 2-3 days after surgery
Complications
There is no procedure that is a 100% safe but EVAR is usually safer than a conventional open aneurysm repair.
The risk of death following EVAR is in most cases less than 3% whereas it is in the order of 7% following conventional surgery.
The most common complications are groin wound infections which in most cases can be managed by a course of oral antibiotics.
There is also the risk of kidney damage which if it does occur usually recovers.
Around 10% of patients will need to have a further smaller operation in the future if a leak is detected around the stent at follow-up. General complications of this type of surgery include a heart attack and chest infection, but these are rare
Going Home and Aftercare
On discharge from hospital you should continue with all your usual medications.
You should resume gentle activity and can get back to normal as and when you feel fit. Sexual activity may be resumed when you feel comfortable.
You will need to have scans using at regular intervals using ultrasound and/or CT to make sure that the graft remains in the correct position.
If you are unsure of anything please get in touch with your GP or ring the hospital and ask to speak to one of the surgical team who looked after you
NB: Your surgeon will advise you on the basis of a CT scan whether it is possible to perform Endovascular Aneurysm Repair (EVAR) surgery. In some cases this is not possible and, if fit enough, you will be offered a more traditional ‘open’ operation.