Surgery for abominal aortic aneurysms

This is high risk surgery on the aorta which is the artery that supplies most of the blood to you abdomen rorgans and lower limbs. About 95% of all Aortic aneurysms (known as AAA's or 'triple A's') occur below the renal (kidney) arteries. The annual risk of rupture of an expanding 5 cm aneurysm is 4%. If the aneurysm ruptures the risk of death is 70-80%. If repaired electively the risk of death is approximately 5%. This means that aortic surgery is associated with a risk of complications associated with other vessel disease already present

Patients presenting for aortic aneurysm surgery are admitted to hospital prior to the day of surgery and assessed by their anaesthetist. Pathology tests, electrocardiogram and cross-matched blood is arranged. If more specialized test are requires these will be arranged pre-operatively. Because of the risk associated with this procedure your surgeon, anaesthetist and theatre staff work as a team to give you the best chance of a successful outcome.

Patients are fasted pre-operatively. Usual medications are continued on the morning of surgery with small sips of water. A wide bore intravenous cannula, central venous line (inserted into the internal jugular vein in the neck) and an arterial line will be inserted by your anaesthetist under local anaesthesia prior to the patient going to sleep. An epidural may also be inserted at this point. The advantages and disadvantages of using an epidural during this procedure will be discussed with you at the time of the pre-anaesthetic assessment.

Patients having AAA surgery will require a full (general) anaesthetic. The operation can take about 4-6 hours. During this time your anaesthetist will control your respiration, pulse, blood preasure, temperature and depth of anaesthesia. The depth of anaesthesia is controlled by the use of narcotics and anaesthetic gases. Blood transfusions are frequently required. Medications such as adrenalin may be required to control and support the heart. If the clamp is above the renal arteries then further medications are used to protect the kidney during cross clamping. At the end of the procedure expect to be transferred to the intensive care unit. You may or may not require further ventilatory support of your breathing at this stage. This often depends on the amount of blood loss, body temperature and your pre-existing medical conditions.

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