This guide is written by the Royal College of Anaesthetists. Used here with permission.
The aorta is a large artery that carries blood from the heart to the major organs (eg liver and kidneys). Within the abdomen, the aorta divides into two arteries, which supply each leg with blood.
There are two main reasons for having an operation on the aorta:
The surgeon replaces part of the aorta with a tube of man-made material similar to nylon. This is a major operation which takes about four hours and which has some risks. Careful preparation and skilled care during your stay in hospital keep these risks to a minimum.
This booklet explains what happens before, during and after the operation and how you can help make your operation a success.
For some patients, a repair to the aorta is possible working through a catheter (tube) inserted into an artery in the groin. It is only suitable for certain patients and certain types of aorta. Your surgeon will be able to tell you if this is recommended for you. It is called Endo-vascular aneurysm repair (or EVAR). Much of the information in this leaflet does not apply if you are having this procedure.
A number of things will happen before you are asked to decide:
The surgeon and anaesthetist will then be able to give you information about what they think the risks of the operation are for you, and what the risks are of not having the operation.
Everyone varies in the risks they are willing to take. The doctors will explain the risks to you, but only you can decide whether to go ahead and have the operation.
Nothing will happen to you until you understand and agree with what has been planned for you. You have the right to refuse if you do not want the operation.
It is important to prepare well for the operation. There is a lot that you can do to improve your fitness.
If you are used to drinking a lot of alcohol, it is helpful to reduce the amount that you drink. Alcohol can reduce the function of your heart and it also causes mild dehydration.
If you are overweight, there is an increase in some of the risks of the anaesthetic and the operation. Losing weight will reduce these risks.
Regular exercise will increase your strength and fitness. There is no need to push yourself – a regular walk at your own pace will boost your stamina.
If you have a long standing medical problem, such as diabetes, asthma, chronic bronchitis, high blood pressure, or epilepsy it is helpful to have a check up from your own GP. In particular, it is important that your blood pressure is well controlled.
You may be asked to come to a pre-assessment clinic a few weeks before your operation. It may be some weeks or months since you saw the surgeon and decided to go ahead with the operation, and an up-to-date health check is needed.
Your anaesthetist will see you when you are admitted to hospital.
An anaesthetist is a doctor who has had specialist training in anaesthesia, in the treatment of pain and in the care of patients in the intensive care unit. He/she may:
The anaesthetist will talk to you about your anaesthetic and methods of pain relief. He/she will be able to answer your questions and discuss any worries that you have.
When you arrive in the reception area you will be met by a theatre nurse. After a brief check to confirm your identity and operation you will be brought to the anaesthetic room.
Many people having this operation are advised to have an epidural for pain relief.
You will be asked to breathe oxygen through a mask while the anaesthetist slowly injects drugs into your ‘drip’. You will not be aware of anything else until the operation is finished. The operation usually takes about four hours.
While you are anaesthetised, you will also have:
After your operation you will be cared for in an intensive care or high dependency unit. Most patients recover consciousness in the operating theatre shortly after the operation is finished. Occasionally it is necessary to continue a light anaesthetic for a few hours until your condition is stable.
On the high dependency or intensive care unit you may have your own nurse or one shared between two patients. Your heart rate, blood pressure, breathing, and kidney function are measured and the fluid that you receive is carefully controlled. Your arterial line and central venous line will stay in place for at least 24 hours after surgery and will be removed as your condition stabilises.
The nurse will also ensure that you are comfortable, usually by attending to your epidural. If the epidural is working effectively (as is usually the case) it can continue for several days, until you are comfortable with pain relief tablets. If the epidural is not effective it is usually removed and you may be given a morphine pump that you control yourself. This is known as patient-controlled analgesia or PCA.
It is very important that you can breathe deeply and cough effectively, to help you avoid a chest infection or pneumonia. A physiotherapist will explain breathing exercises to you and help you to cough vigorously. The intensive care nurses will also encourage you to do these exercises regularly.
The nurses will also encourage you to move your legs to prevent deep venous thrombosis (DVT, or clots in the leg veins).
When the surgeon, anaesthetist and intensive care unit staff are satisfied that you are recovering safely, you will return to the surgical ward.
You may still develop a chest infection 3 or 4 days after the operation so it is important to continue your breathing exercises.
Although this is a major operation, about 19 out of 20 people survive this type of surgery. The risk to you as an individual will depend on:
Serious complications include heart attack (1 in 20), a degree of kidney failure (1 in 8–10), and a blood clot on the lungs (1 in 100).
Most intensive care units have information leaflets available for patients and relatives. Sometimes you can visit the intensive care unit beforehand so that you know what to expect.
21 Portland Place
London W1B 1PY
Phone: +44 20 7631 1650
Fax: +44 20 7631 4352
This organisation works to promote the development of anaesthesia and the welfare of anaesthetists and their patients in Great Britain and Ireland.
35 Red Lion Square
London WC1R 4SG
Phone: + 44 20 7092 1500
Fax: + 44 20 7092 1730
This organisation is responsible for standards in anaesthesia, critical care and pain management throughout the UK.
This guide was written by The Royal College of Anaesthetists, Churchill House, 35 Red Lion Square, London WC1R 4SG. © 2002, RCoA (3rd edition - May 2008). Copyright for this article is with the Royal College of Anaesthetists.