ABDOMINAL AORTIC ANEURYSM  (AAA)

What is it?

                Arteries carry blood away from the heart.  The aorta, the main artery leading away from the heart, can sometimes develop an aneurysm.  Aneurysms usually occur in the abdomen below the kidneys (abdominal aneurysm). 

                An aneurysm is a bulge in the arterial wall.  This can happen if the wall of the aorta is damaged by arteriosclerosis.  Arteriosclerosis begins with insults to the innermost lining of an artery.  Proven insults are high cholesterol, triglycerides or blood sugar in the blood, high blood pressure and tobacco smoke.  Arteriosclerosis can weaken the walls of the artery leading to an aneurysmal dilation.

 

Now what can I do?

                If you minimize your risk factors you will aid in preventing further damage to your arteries.  Risk factors that you can control and improve are: STOP SMOKING TOBACCO, keep your cholesterol low, control your diabetes, lose weight, and become more physically active.

 

What are my treatment options?

                You may already have had an angiogram or a CAT Scan to help determine the position of your aneurysm.  Aneurysms are dangerous because they may burst.  There are two (2) surgical approaches to repairing the aneurysm.  An open surgical repair is done through an incision in the abdomen to reach and repair the artery by cutting out the diseased portion of the artery.  It uses a Dacron graft to replace the vessel wall. The endovascular approach gains access from the groin arteries and repairs the artery from within the blood vessel.  Some differences between the two approaches are demonstrated in the table below.

 

Differences

Open Approach

Endovascular Approach

Selection criteria

Size and growth rate of aneurysm
  1. Neck of aneurysm straight and not too large.
  2. Outflow from aneurysm not too large or too blocked.

Incision size/location

Larger: abdomen

Smaller: both groin creases

Surgery length

3-5 hours

2-3 hours

Hospital stay

5-7 days

2-3 days

Recovery time

4-6 weeks

2-3 weeks

Follow-up tests

CAT Scan: None needed

CAT Scan at 3months, 12 months, and annually thereafter.

 

What happens at the hospital?

  • Surgery is done as an inpatient.  The day of your surgery, you must check in 2 hours before your surgery time.
  • Your procedure will be under anesthesia.  You will speak with an anesthesiologist before your procedure.
  • After surgery, you may be monitored in the Intensive Care Unit (ICU).  You can go home after you can get in and out of bed & walk independently.
  • You will be given a prescription for pain medication before you leave the hospital.

 

What should I expect after I go home?

  • Each day you will see improvement around your incision site and lessening of soreness.  Bruising is a normal development.
  • You should resume normal eating and exercise patterns as soon as possible.
  • You should resume normal sleep/wake cycles as soon as possible.
  • You should shower regularly.  You need to wash the wound vigorously with soap and water to prevent infections.
  • You may drive after about three (3) weeks when you feel safe.
  • You will be seen in our office 10-14 days after being home.

 

Scheduling your Surgery

 

  1. You will be notified of the date and time of your surgery by our office.
  2. You need a Physical Exam by your primary care physician within a month of your surgery.  Call to schedule this appointment with him/her after you have your surgery date.
  3. You will also need to Pre-register with the hospital within 14 days prior to your surgery.  Please bring your insurance card and a list of your medications.

(See Pre-registration Packet)

        CPMC, Pre-registration and Learning Center   (415) 600-2500

1825 Sacramento Street (@ Van Ness Avenue).

Call for an appointment to pre-register. 

  1. The location to check in the day of your surgery is:

              Open Surgical repair of AAA                                                               Endovascular Surgical repair of AAA

                 CPMC, Ambulatory Care Unit (ACU)                                                   CPMC, Ambulatory Care Unit

                 2351 Clay St @ Webster St., 6th floor                                                    2351 Clay St @ Webster St., 6th floor                                                    

  1. You are not to eat solid food for or drink milk products 8 hours prior to surgery.  You may drink ONLY clear liquids up to 5 hours prior to surgery.
  2. Doctor will see you at the hospital the day of your surgery.

 

VASCULAR SPECIALISTS of SAN FRANCISCO
Dr. John Long, Dr. Marc Levine, Dr. Daniel Nathanson
3838 California St., Suite 612
San Francisco, CA 94118
415-221-7056       fax 415-221-7058