Aneurysm Surgery

An aneurysm is a weakened area of an artery that bulges or expands. Aneurysms can occur anywhere, however, most commonly occur in the aorta (major artery of the chest and abdomen), iliac artery (major artery of the pelvis), popliteal artery (in the leg behind the knee), mesenteric artery (supplying the intestine), and splenic artery (supplying the spleen). Aneurysms can develop slowly over many years; often cause no signs or symptoms, and are not always life-threatening.

Usually aneurysms are carefully monitored. If your aneurysm is small, your doctor will follow-up every 6 to 12 months for signs of changes in the aneurysm size (bulge). However, once the aneurysm’s bulge starts stretching the artery too far, symptoms (chest, abdominal or back pain) will appear. This may indicate that the aneurysm is on the verge of bursting and require an emergency surgery.

Aneurysm surgery is performed using the following methods: Minimally-Invasive (small incisions of 2–3 inches long / general anesthesia), or through open-surgery (large incisions of 8-10 inches long / general anesthesia). The type of method chosen will vary according to your particular health condition.

Do you have a question? Request more information and we will connect you with an RWJBarnabas Health cardiovascular expert.

Types of Aneurysm Surgery

There are several types of aneurysm surgeries:

• Coil Embolization: A minimally-invasive procedure that treats the aneurysm by filling it with material that closes off the sac and reduces the risk of bleeding. It is performed through the use of a catheter that is inserted through an artery in the groin and guided to affected area. Tiny coils, glue, or mesh stents are used to promote clotting and close off the aneurysm.
• Surgical Clipping: The goal of this procedure is to isolate the aneurysm from the normal blood circulation without blocking off any small perforating arteries nearby. The clip works like a tiny coil-spring clothespin, in which the blades of the clip remain tightly closed until pressure is applied to open the blades. Clips are made of titanium and remain on the artery permanently.
• Open-Surgery: This type of procedure involves complete removal of the aneurysm. Once the surgeon gains access to the aneurysm, he or she will place clamps on the area above and below the aneurysm. This stops blood flow through the area being worked on. Afterwards, the aneurysm is removed.

How to Prepare for the Procedure

Before the procedure, your doctor and treatment team will explain to you what to expect before, during and after the procedure, and potential risks of the procedure. Talk to your doctor about:

• All medications, herbal products and dietary supplements you are currently taking and ask for their recommendations about each.
• Diabetes and how to adjust your medicine on the day of the procedure.
• Radiation exposure, especially for those that are pregnant.
• Any allergies to medicines, latex, tape, iodine, and anesthetic agents.
• Any history of bleeding disorders.
• Any family history of such aneurysms.
• Any implanted device (e.g. pacemaker or ICD).
• Any body piercings on your chest or abdomen.

Other recommendations include:

• Eat a normal meal the evening before the procedure. However, do not eat, drink or chew anything after midnight before your procedure. If you must take medications, only take them with sips of water.
• Leave all jewelry at home.
• Remove all makeup and nail polish.
• Wear comfortable clothing when you come to the hospital.
• If you normally wear dentures, glasses, or hearing devices at home, plan to wear them during the procedure.

What to Expect Before the Procedure

To determine whether you need an aneurysm repair, your doctor might perform a variety of diagnostic tests, including:

• Computed Tomography (CT scan)
• Magnetic Resonance Imaging (MRI)
• Ultrasound
• Angiogram

What to Expect During the Procedure

^{Medical Animation Copyright © 2019 Nucleus Medical Media, All rights reserved.}

As previously mentioned, aortic aneurysms are the most common type of aneurysm. To repair such, minimally-invasive methods are usually preferred. This type of surgery can take as few as 2 and as many as 8 hours, but the preparation and recovery may add several hours. The procedure is usually performed in the operating room (OR). Check with your doctor about the details of your procedure. In general:

You will change into a hospital gown. A nurse will start the intravenous (IV) line in your arm which will administer medications and fluids during the procedure. Prior to starting the procedure, you will receive a local anesthetic. Once you are sedated, your doctor may insert a breathing tube through your throat into your lungs and connect you to a ventilator. This will breathe for you during surgery.

You doctor may choose regional anesthesia instead of general anesthesia. Regional anesthesia is delivered through an epidural (in the back) to numb area operated on. While general anesthesia will make you feel sleepy. The doctor will determine which type of anesthesia is appropriate.

The procedure begins when your doctor makes an incision from the breast bone to below the naval. Through this opening, your doctor will be able to identify the aneurysm. Your doctor will then proceed to clamp the aorta just above and below the aneurysm. Your doctor will then cut open the aneurysm and proceed to sew an artificial graft.

Once the procedure is completed, your doctor will sew the wall of the aneurysm close over the new graft. The graft will reinforce the walls of the aorta. Your doctor will sew the incision closed with stitches.

What to Expect After the Procedure

After the procedure, you may be taken to the recovery room for further observation. Patients frequently go home the following day, but sometimes complexity of the surgery or other factors require a longer stay. Other recommendations include:

General Guidelines

• A nurse will monitor your vital signs, the insertion site, circulation and sensation in your extremities.
• You may be on special IV medicines to help your blood pressure and your heart, and to control any problems with bleeding.
• You can typically walk around and eat and drink normally the day after surgery.
• Nurses, respiratory therapists, and physical therapists will work with you as you begin physical therapy and breathing exercises.
• Your doctor will give you instructions to follow during your recovery.

Do you have a question? Request more information and we will connect you with an RWJBarnabas Health cardiovascular expert.