Abdominal Aortic Aneurysm

Summary

This script outlines the surgical procedures for abdominal aortic aneurysm repair, a condition where the abdominal aorta bulges due to high blood pressure. Two methods are described: open repair, involving a large incision and graft placement, and endovascular repair, a minimally invasive approach using a stent graft. The script details the pre-surgery preparations, anesthesia, surgical steps, and post-operative care, highlighting the differences in recovery times between the two procedures.

Takeaways

• 🩺 The abdominal aortic aneurysm repair is a surgical procedure to prevent the rupture of a bulging area in the abdominal aorta, the largest artery in the body.
• 🔍 The aorta is divided into four parts: ascending aorta, aortic arch, thoracic aorta, and abdominal aorta, with the abdominal aorta being the last and largest section.
• 📏 An open abdominal aortic aneurysm repair is performed when the aorta's diameter exceeds 2 inches or if symptoms like intense abdominal pain are present.
• 💉 Before surgery, an IV line is started for fluids, antibiotics, and anesthesia; a breathing tube and a bladder catheter may also be inserted.
• ✂️ The open surgical repair involves an incision from the breastbone to below the navel, locating the aneurysm, and clamping the aorta above and below it.
• 🧵 The surgeon sews an artificial graft, the same size and shape as a healthy aorta, into place and stitches the aneurysm wall closed over the graft.
• 🛑 Endovascular aneurysm repair is a minimally invasive procedure used for patients with severe heart disease or increased surgical risk.
• 🩹 In endovascular repair, a small incision is made in the groin, and a guide wire is inserted into the femoral artery to guide a catheter with a stent graft to the aneurysm site.
• 🔄 The stent graft is opened within the aneurysm, held in place with hooks and stents, redirecting blood flow away from the aneurysm sac.
• ⏱️ The open procedure typically takes 4 to 6 hours, while the endovascular procedure takes about 2 to 3 hours.
• 🏥 Post-surgery recovery for an open procedure involves a 5 to 10-day hospital stay, whereas the endovascular procedure usually requires a shorter stay of 2 to 3 days.

Q & A

What is an abdominal aortic aneurysm?

An abdominal aortic aneurysm is a bulging area in the abdominal section of the aorta, which is the largest artery in the body responsible for carrying blood from the heart to the lower regions of the body.

Why is an abdominal aortic aneurysm repair necessary?

An abdominal aortic aneurysm repair is necessary to prevent the rupture of the bulging area in the aorta, which can be life-threatening.

What are the four parts of the aorta?

The aorta is divided into the ascending aorta, aortic arch, thoracic aorta, and abdominal aorta.

How does the abdominal aorta differ from other sections of the aorta?

The abdominal aorta is the last and largest section of the aorta, supplying blood to the lower regions of the body, including the organs in the abdomen and pelvis.

What are the indications for open abdominal aortic aneurysm repair?

Open abdominal aortic aneurysm repair is indicated when the diameter of the aorta exceeds 2 inches or if a patient is experiencing symptoms like intense abdominal pain or an abnormally prominent abdominal pulsation.

What happens during the open abdominal aortic aneurysm repair procedure?

During the open repair, the surgeon makes an incision, locates the aneurysm, clamps the aorta, sews an artificial graft into place, and stitches the wall of the aneurysm closed over the graft.

What is an endovascular aneurysm repair?

Endovascular aneurysm repair is a minimally invasive procedure used for patients with severe heart disease or those at increased surgical risk, where a stent graft is inserted into the blood vessels to reinforce the aorta.

How is the endovascular stent graft inserted during the procedure?

The endovascular stent graft is inserted by making a small incision in the groin, inserting a guide wire and catheter, and then passing the compressed graft through the catheter to the aneurysm site.

What is the difference in recovery time between open and endovascular procedures?

The usual hospital stay for an open procedure is 5 to 10 days, while the stay for an endovascular procedure is usually shorter at two to three days.

What are the steps taken to ensure patient safety during the surgical procedures?

Safety measures include starting an IV line for fluids and antibiotics, administering general anesthesia or regional anesthesia, inserting a breathing tube and a bladder catheter, and monitoring kidney function.

Outlines

00:00

🩺 Abdominal Aortic Aneurysm Repair

The paragraph discusses the surgical procedure for repairing an abdominal aortic aneurysm, a bulging in the abdominal section of the aorta. The aorta, being the body's largest artery, is divided into four parts, with the abdominal aorta being the last and largest, supplying blood to the lower body. When the aortic wall weakens and bulges, it's termed an abdominal aortic aneurysm. The surgical repair involves either an open procedure, where an incision is made from the breastbone to below the navel, and an artificial graft is sewn in place over the aneurysm, or an endovascular procedure, which is less invasive and involves inserting a stent graft through the femoral artery to the aneurysm site. Both procedures aim to reinforce the aortic wall and prevent rupture, with the open procedure typically taking 4 to 6 hours and the endovascular around 2 to 3 hours.

Keywords

💡Abdominal Aortic Aneurysm

An abdominal aortic aneurysm (AAA) is a life-threatening medical condition where the abdominal section of the aorta, the body's largest artery, weakens and bulges. This condition can lead to a rupture, which is often fatal. In the video, the necessity for surgical intervention is discussed when the aneurysm reaches a diameter of 2 inches or when symptoms like abdominal pain or an abnormal pulsation are present.

💡Aorta

The aorta is the main and largest artery in the human body, originating from the left ventricle of the heart and extending down to the abdomen. It is responsible for carrying oxygenated blood to the rest of the body. The script mentions that the aorta is divided into four parts, with the abdominal aorta being the focus of the video due to its susceptibility to aneurysms.

💡Open Abdominal Aortic Aneurysm Repair

This is a surgical procedure to treat an abdominal aortic aneurysm by making an incision in the abdomen and replacing the diseased section of the aorta with an artificial graft. The video describes this as a traditional method, requiring general anesthesia and a longer recovery time, with an incision from the breastbone to below the navel.

💡Endovascular Aneurysm Repair

Endovascular aneurysm repair (EVAR) is a minimally invasive surgical technique used to treat aneurysms. Unlike open repair, EVAR involves making a small incision in the groin and using a catheter to place a stent graft within the aorta, thereby excluding the aneurysm from the circulation. The video highlights EVAR as a preferred method for patients with increased surgical risk.

💡Aneurysm

An aneurysm refers to a localized, blood-filled balloon-like bulge in the wall of a blood vessel. The term is central to the video's theme, as it describes the abnormal bulging of the aorta that can lead to life-threatening complications. The video discusses two types of repair procedures to address this condition.

💡Artificial Graft

An artificial graft is a tube-like device made of synthetic material used in vascular surgery to replace a diseased or damaged blood vessel. In the context of the video, the graft is used in both open and endovascular repairs to reinforce the aortic wall and prevent the aneurysm from rupturing.

💡General Anesthesia

General anesthesia is a type of anesthesia that induces a state of unconsciousness, preventing the patient from feeling pain and movement during surgery. The video mentions that traditional open surgical repair is performed under general anesthesia, ensuring the patient is asleep throughout the procedure.

💡Femoral Artery

The femoral artery is a major blood vessel in the groin that supplies blood to the lower body. In the video, the femoral artery is the entry point for the endovascular stent graft during EVAR, highlighting its strategic location for minimally invasive procedures.

💡Stent Graft

A stent graft is a combination of a stent, a scaffolding device, and a graft, used to treat various vascular disorders by reinforcing or replacing a damaged blood vessel. In the video, the stent graft is used in EVAR to line the inside of the aorta and divert blood flow away from the aneurysm.

💡Intensive Care Unit (ICU)

The Intensive Care Unit is a specialized hospital unit designed to provide close monitoring and treatment for patients with severe or life-threatening conditions. The video notes that patients who have had a breathing tube inserted during surgery are taken to the ICU for recovery, emphasizing the critical nature of postoperative care.

💡Hospital Stay

Hospital stay refers to the duration a patient spends in the hospital for treatment or recovery. The video contrasts the typical hospital stay for open and endovascular procedures, with the former being 5 to 10 days and the latter being 2 to 3 days, indicating the less invasive nature of EVAR.

Highlights

Abdominal aortic aneurysm repair is a surgical procedure to prevent the rupture of a bulging aorta.

The aorta is the largest artery in the body, receiving blood directly from the left ventricle.

The abdominal aorta is the last and largest section of the aorta, supplying blood to the lower body.

An abdominal aortic aneurysm is a condition where the abdominal aorta wall bulges outward.

Open abdominal aortic aneurysm repair is performed when the aorta diameter exceeds 2 inches or with symptoms.

Before surgery, an IV line is started for fluids, antibiotics, and anesthesia.

General anesthesia is used for the open surgical repair, ensuring the patient is asleep during the procedure.

A breathing tube is inserted to assist with breathing during the operation.

A catheter is used to drain urine and monitor kidney function.

The surgeon makes an incision from the breastbone to below the navel to access the aneurysm.

An artificial graft is sewn into place to reinforce the aorta's walls.

The abdominal incision is closed with stitches after graft placement.

Endovascular aneurysm repair is a minimally invasive procedure for high-risk patients.

IV line is also started before the endovascular procedure for fluids and antibiotics.

General anesthesia or regional anesthesia may be used for the endovascular procedure.

A small incision in the groin allows for the insertion of a guide wire and catheter to the aneurysm site.

An endovascular stent graft is compressed and passed through the catheter to the aneurysm.

The stent graft is opened and held in place with metallic hooks and stents.

Additional graft components may be inserted to extend into the blood vessels supplying the legs.

The procedure redirects blood flow through the graft, relieving pressure on the aneurysm.

Post-procedure recovery includes removal of the breathing tube and transfer to the ICU.

Hospital stay for open surgery is typically 5 to 10 days, while endovascular is 2 to 3 days.

Transcripts

your surgeon will perform an abdominal

aortic aneurysm repair to prevent the

rupture of a bulging area of your aorta

the largest artery in the body is the

aorta which is attached to the heart and

receives blood directly from the left

ventricle or main pumping chamber the

aorta is divided into four parts the

ascending aorta aortic Arch thoracic

aorta and the abdominal aorta

the abdominal aorta is the last and

largest section of the aorta IT Supplies

blood to the lower regions of your body

including the organs in the abdomen and

pelvis the abdominal aorta ends around

Naval level where it splits into the two

iliac arteries that carry blood to the

legs the aorta has a thick wall so it

can withstand the high pressure of blood

being pumped from the heart over time

the wall of the aorta May weak

slowly bulging outward like a balloon

when this condition occurs in the

abdominal region it is called an

abdominal aortic aneurysm your surgeon

will perform an open abdominal aortic

aneurysm repair when the diameter of

your aorta exceeds 2 in or if you're

having symptoms such as intense

abdominal pain or an abnormally

prominent abdominal pulsation before the

open procedure an IV line will be

started to provide you with fluids

antibiotics and anesthesia a traditional

open surgical repair is performed under

general anesthesia which means you will

be asleep for the duration of the

procedure a breathing tube will be

inserted through your mouth and into

your windpipe to help you breathe during

the operation when you're asleep a

catheter will be inserted into your

bladder to drain your urine and monitor

your kidney function your surgeon will

Begin by making an incision from the

breast bone to below the navl he or she

will then locate the aneurysm and clamp

the aorta just above and below it your

surgeon will then open the aneurysm and

sew an artificial graft the same size

and shape as a healthy aorta into

place your surgeon will Stitch the wall

of the aneurysm closed over the newly

placed graft

The graft will reinforce the walls of

the aorta your surgeon will close the

abdominal incision with stitches the

total length of this procedure is

usually 4 to 6 hours your surgeon will

perform endovascular aneurism repair a

newer minimally invasive procedure if

you have severe heart disease or are at

increased surgical risk due to age or

other medical

conditions before the endovascular

procedure as with the open procedure an

IV line will be started to provide you

with fluids and

antibiotics you may receive general

anesthesia or you may receive a sedative

in an epidural or Regional anesthesia to

numb only the lower half of your body

your surgeon will Begin by making a

small incision in your groin over your

femoral artery then he or she will

insert a guide wire into the artery and

gently push it up toward the sight of

your

aneurysm a catheter or Hollow tube will

be passed over the guide wire and pushed

toward your

aneurysm using live X-ray pictures as a

guide your surgeon will pass an

endovascular stent graft a compressed

Fabric and metal tube through the

catheter to the aneurysm then he or she

will open the graft which will be held

in place with metallic hook and

stance your surgeon May insert

additional graft components to extend

the graft into the blood vessels

supplying your

legs once the graft is in place your

blood will flow through it not into the

surrounding aneurysm Sac which will

remove the pressure from your

aneurysm finally your surgeon will

remove the catheters and close the

incisions in your groin the procedure

will generally Take 2 to 3

hours after your procedure if you had a

breathing tube it will be removed and

you will be taken to the Intensive Care

Unit for Recovery you will receive

fluids and nutrition through your IV you

may also have a tube inserted through

your nose and into your stomach to

remove secretions until your intestines

regain normal functioning the usual

Hospital stay for an open procedure is 5

to 10 days while the stay for an

endovascular procedure is usually

shorter at two to 3 days