Aortic aneurysm repair - endovascular - discharge
AAA repair - endovascular - discharge; Repair - aortic aneurysm - endovascular - discharge; EVAR - discharge; Endovascular aneurysm repair - discharge
Endovascular abdominal aortic aneurysm (AAA) repair is surgery to repair a widened area in your aorta. This is called an aneurysm. The aorta is the large artery that carries blood to your belly, pelvis, and legs.
Your blood vessels are the transport system that carries blood to and from your heart, to the rest of your body. Usually, everything runs pretty smoothly with this system, but sometimes there can be a problem. For example, one of the large blood vessels that supplies blood to your abdomen and lower body can swell up or bulge. This bulge is called an abdominal aortic aneurysm, and it can be pretty serious if it breaks open, or ruptures. Let's talk about abdominal aortic aneurysm. This is the descending aorta, one of the large blood vessels that sends blood to your abdomen and legs. Over a period of many years, this blood vessel can start to bulge. Although doctors aren't sure exactly what causes an aneurysm, they do know that it's more common in males over 60 and people who are overweight, who smoke, or who have high blood pressure or cholesterol. Eventually, if not treated, the aneurysm can pop open or rupture, and spill blood into your abdominal cavity or into the wall of the artery. If an aneurysm ruptures, it is considered a true medical emergency. So, how do you find out if you have an aneurysm? You may not realize that you have one, because often aneurysms don't cause any symptoms until they rupture. An imaging test like a CT scan or ultrasound may help in finding a suspected aneurysm. If it does break open, you may feel severe pain in your stomach. That pain may spread to your groin, buttocks, or legs. You could also feel sick to your stomach, have clammy skin, and your heart may beat faster than normal. If you have any of these symptoms, see your doctor, who can examine you. Your doctor may also recommend an imaging test to see for sure if you have an aneurysm. Treatments for aneurysms vary depending on how severe the aneurysm is. If you're not having symptoms, and your aneurysm is small and hasn't broken open, your doctor may suggest just checking it every six months to make sure it doesn't get bigger. If it's bigger than 2 inches, you'll probably need to have surgery. The goal is to perform surgery before complications and symptoms develop. The surgeon will replace the damaged, bulging section of blood vessel with a section of man-made vessel, commonly called a graft. It's better to avoid getting an aneurysm than to have to treat it. Eat a healthy diet, watch your cholesterol and blood pressure levels, and quit smoking to help prevent an aneurysm from forming in the first place. Men who are over the age of 65 and have ever smoked or who have a close relative who's had an abdominal aortic aneurysm should have one screening ultrasound done to check for an abdominal aortic aneurysm. If you're having any symptoms of an abdominal aneurysm, like severe pain in your belly or back, it's very important that you get medical help right away. Go to the emergency room or call your health care provider for immediate help. Small aneurysms are easy to treat with surgery. But once they get larger and rupture, they can be life threatening.
When You're in the Hospital
You had endovascular aortic surgery repair for an aneurysm (a widened part) of the large artery that carries blood to your lower body (aorta).
To perform the procedure:
- Your doctor made a small incision (cut) near your groin to find your femoral artery.
- A large tube was inserted into the artery so that other instruments could be inserted.
- An incision may have been made in the other groin as well as the arm.
- Your doctor inserted a stent and a man-made (synthetic) graft through the incision into the artery.
- X-rays were used to guide the stent and graft into your aorta where the aneurysm was located.
- The graft and stent were opened up and attached to the walls of the aorta.
What to Expect at Home
The cut in your groin may be sore for several days. You should be able to walk farther now without needing to rest. But you should take it easy at first. It may take 6 to 8 weeks to fully recover. You may feel discomfort in your abdomen for a few days. You may also have a loss of appetite. This will get better over the next week. You may have constipation or diarrhea for a short time.
You will need to increase your activity slowly while the incision heals.
- Walking short distances on a flat surface is OK. Try to walk a little, 3 or 4 times a day. Slowly increase how far you walk each time.
- Limit going up and down stairs to about 2 times a day for the first 2 to 3 days after the procedure.
- Do not do yard work, drive, or play sports for at least 2 days, or for the number of days your health care provider tells you to wait.
- Do not lift anything heavier than 10 pounds (4.5 kg) for 2 weeks after the procedure.
- Your provider will tell you how often to change your dressing.
- If your incision bleeds or swells, lie down and put pressure on it for 30 minutes, and call your provider.
When you are resting, try keeping your legs raised above the level of your heart. Place pillows or blankets under your legs to raise them.
Ask your provider about follow-up x-rays you will need to have to check if your new graft is OK. Having regular checkups to make sure your graft is working well is a very important part of your care.
Your provider may ask you to take aspirin or another medicine called clopidogrel (Plavix) when you go home. These medicines are antiplatelet agents. They prevent the platelets in your blood from clumping together and forming clots in your arteries or stent. Do not stop taking them without talking with your provider first.
Endovascular surgery does not cure the underlying problem with your blood vessels. Other blood vessels could be affected in the future. Therefore, it is important to make the lifestyle changes and take the medicines your provider recommends.
- Eat a heart-healthy diet.
- Get regular exercise.
- Stop smoking (if you smoke).
Take all medicines your doctor has prescribed as directed. This may include medicines to lower cholesterol, manage high blood pressure, and treat diabetes.
When to Call the Doctor
Call your provider if:
- You have pain in your belly or back that does not go away or is very bad.
- There is bleeding at the catheter insertion site that does not stop when pressure is applied.
- There is swelling at the catheter site.
- Your leg or arm below where the catheter was inserted changes color, becomes cool to the touch, pale, or numb.
- The small incision for your catheter becomes red or painful.
- Yellow or green discharge is draining from the incision for your catheter.
- Your legs are swelling.
- You have chest pain or shortness of breath that does not go away with rest.
- You have dizziness or fainting, or you are very tired.
- You are coughing up blood, or yellow or green mucus.
- You have chills or a fever over 101°F (38.3°C).
- You have blood in your stool.
- Your urine becomes dark colored or you do not urinate as much as usual.
- You are not able to move your legs.
- Your belly starts to swell and is painful.
Binster CJ, Sternbergh WC. Endovascular aneurysm repair techniques. In: Sidawy AN, Perler BA, eds. Rutherford's Vascular Surgery and Endovascular Therapy. 9th ed. Philadelphia, PA: Elsevier; 2019:chap 73.
Braverman AC, Schermerhorn M. Diseases of the aorta. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 63.
Cambria RP, Prushik SG. Endovascular treatment of abdominal aortic aneurysms. In: Cameron AM, Cameron JL, eds. Current Surgical Therapy. 13th ed. Philadelphia, PA: Elsevier; 2020:905-911.
Tracci MC, Cherry KJ. The aorta. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 20th ed. Philadelphia, PA: Elsevier; 2017:chap 61.
Uberoi R, Hadi M. Aortic intervention. In: Adam A, Dixon AK, Gillard JH, Schaefer-Prokop CM, eds. Grainger & Allison's Diagnostic Radiology: A Textbook of Medical Imaging. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 79.
Last reviewed on: 6/16/2020
Reviewed by: Deepak Sudheendra, MD, RPVI, FSIR, Director of DVT & Complex Venous Disease Program, Assistant Professor of Interventional Radiology & Surgery at the University of Pennsylvania Perelman School of Medicine, with an expertise in Vascular Interventional Radiology & Surgical Critical Care, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.