Abdominal aortic aneurysmectomy
What is it?
When is this procedure indicated?
This intervention is indicated in abdominal aortic aneurysms at various levels (subrenal, iuxtarenal, pararenal) and of various etiologies (degenerative/atherosclerotic, inflammatory, mycotic). These pathologies require a replacement of the aorta in the abdominal tract affected by the aneurysmal pathology; the main purpose of the procedure is to eliminate the risk of rupture of the aneurysm. This procedure can also be used in cases of surgical conversion after previous endovascular procedures, when the latter are complicated by endoleak (reperfusion of the aneurysmal sac) or infection of the endoprosthesis.
How is it performed?
The intervention consists in the replacement of the stretch of aorta affected by pathology with a prosthesis made of biocompatible material. The intervention is performed under general anesthesia and uses some anesthesiological aids for post-operative pain control (placement of a catheter for pain control in the first days after surgery). The intervention involves the following steps:
Step 1
incision of the abdominal wall (median);
Step 2
release of the diseased aorta from adhesions with surrounding tissues. This phase can be very delicate because of the delicate relationship of the aorta to the abdominal level (intestine, pancreas, etc..);
Step 3
closure (clamping) of the aorta proximally and distally the diseased tract and start of perfusion strategies if the ischemia induced by the closure of the aorta also involves the renal arteries;
Step 4
replacement of the diseased aorta with dedicated prosthesis;
Step 5
completion of the suture between prosthesis and aorta and eventual reconstruction of vessels arising from the latter (in case of pararenal aneurysms, renal arteries).
Recovery
After discharge, a patient still needs a 2 week convalescence period at home or rehabilitation before fully resuming his/her previous activities. In this period, it is normal to feel rather weak, not having appetite. In this period it is important to gradually resume physical activity, trying, in progressive autonomy, to take short walks, with the aim of doing every day something more than the previous day.
Short-term complications
Complications following such an important intervention are still frequent; they can be less impacting in the long term, such as surgical wound infections, or urinary and respiratory infections, but they can also be very serious, and cause visceral ischemia with colon ischemia also requiring re-intervention, renal ischemia of various degrees, also conditioning renal failure with possible need of transient or permanent dialysis, bleeding, re-interventions, respiratory or cardiovascular failure.
These are the data related to the complications observed in our Aortic Center, reference center for these pathologies at national level.
Long-term complications
Long-term complications include:
- surgical wound infection causing dehiscence, requiring advanced dressings to heal by second intention;
- sudden or progressive occlusion that can cause lower extremity ischemia;
- pseudoaneurysms;
- prosthesis infection;
- laparocele.
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