Ανεύρυσμα κοιλιακής αορτής – Ανοικτή αποκατάσταση
The intended benefits: to prolong life by preventing rupture of your aneurysm.
1. Some patients live on without rupture for some time, especially with smaller aneurysms and some may survive emergency surgery after rupture, only 10-20% do survive rupture though. Once aortic aneurysms exceed 5-6 cm in diameter, they are safest if repaired for most patients. The risk of surgery for you will be carefully assessed with several tests and a Consultant Anaesthetist review and discussed with you.
2. Endovascular repair or EVAR will also already have been considered and discussed for you but is not always feasible for technical reasons. Nor is EVAR preferable in all patients, especially for younger patients blow 70 years, as it may not be a durable cure.
Serious or frequently occurring risks: while repairing the aneurysm, blood flow through it to the lower half of the body is disturbed, more so to the legs. This puts strain on the heart, lungs and kidneys and can cause one or more of them to fail, together with a small risk of stroke. we monitor these organ functions carefully and can usually treat them, but severe failures of one or multiple organs are occasionally fatal despite treatment. Prolonged recovery or not returning to your former level of fitness and functions can occur and is more likely after a serious complication. Bleeding in the abdomen is rare because we take great care to avoid it but it can also be dangerous if unchecked and may require a return to the operating theatre. Circulation to the legs or feet can occasionally become blocked after the operation and we must operate to try to restore the circulation. Uncommonly this leads to loss of toes or rarely, a leg if the blood supply cannot be re-established. More rarely, circulation to the bowel is lost and this also needs surgery to remove the affected bowel as it quickly dies with no blood supply resulting in peritonitis, sepsis and death if not treated successfully. This may leave you with a stoma, where the bowels empty into a bag on your tummy. Later on, the bowel sometimes develops a blockage due to internal scars which we call adhesions, these can occur after any abdominal surgery but resulting blockage of the bowel is not common after aneurysm surgery. Very rarely the circulation to the spinal cord is lost, leading to paraplegia. It is a little more common for kidneys to be affected, either temporarily or sometimes permanently. A machine (dialysis) can be used to replace the kidneys when required. At any time after it is inserted, the graft may become infected. Whilst rare, this is serious because it is difficult to treat successfully and may need the graft to be removed. Antibiotics may help to prolong life but will not usually cure this type of infection. The surgery requires a large cut on your abdomen .Early on, the wound may ooze or bleed and any collection of blood may need removal. Alternatively the wound may become inflamed and infected needing antibiotics and dressings. Later on, a bulge may appear in the wound, an incisional hernia. These bulges may not require any treatment but can become large or painful; surgery can be done to repair these hernias but is not always straightforward or successful in the longer term and is another big operation. Erectile dysfunction interfering with sexual activity is common in men after the repair.
Modern anaesthetics are generally very safe and you will have the opportunity discuss this in detail with your Anaesthetist. . Commoner side effects(1 in 10-100) include: nausea or vomiting, sore throat, dizziness, blurred vision, headache, itching, bruising and soreness, pain during drug injection, confusion or memory loss, aches, pains and backache. . Uncommon problems (1 in 1000) include: problems passing urine, muscle pains, slow breathing, damage to teeth, lips or tongue or worsening of an existing medical condition. Rare complications (1 in 10,000-100,000) include damage to the eyes, serious allergy to drugs, nerve damage, awareness during surgery, equipment failure and death.
It is very likely your Anaesthetist will recommend an epidural for pain relief for this operation; commoner side effects include:
Commoner side effects of an epidural or spinal anaesthesia include:
- Inability to pass urine: bladder function will return to normal after the epidural wears off
- Low blood pressure
- Itching, feeling sick and vomiting or headache
- Backache is common after surgery and not always related to the epidural
- Inadequate pain relief- other methods of pain relief will be used if the epidural fails.
Uncommon complications include slow breathing and epidural catheter infection. Rare or very rare complications include fits, permanent disabling nerve damage, epidural infection, epidural blood clot and cardiac arrest.
Overall for open aneurysm repair, death occurs in around 3-4% and major complications in another 5%.
Any extra procedures which may become necessary during the operation:
- Blood transfusion is rarely needed unless you are already anaemic but transfusions can result in severe allergic reactions or infections despite careful screening of the blood for you
- Photographs and images X-rays are a usual part of this operation but if we want images for teaching or research purposes, we would always ask your special permission
- Other procedures, except for those listed above, are not often required during this operation unless planned in advance, the problems listed above can lead to additional procedures as described.
Statement of Health Professional
I have explained the procedure to the patient. In particular, I have checked through all of the above information and confirm that the patient has read this form and wants to proceed.