Aortic Aneurysm Repair

A surgical procedure done to fix an aortic aneurysm is known as an aortic aneurysm repair surgery. An aortic aneurysm is a weakened area seen in the aorta, which is the main blood vessel or artery that leaves the heart and passes down the chest and abdomen (stomach region). 

The weakened part of the aorta can grow, stretch, and balloon outward with time. If the weakened area is left untreated, the aortic aneurysm can burst and cause heavy bleeding, which may be life-threatening. An aortic aneurysm repair surgery involves the removal or reinforcement of the diseased part of the aorta with a synthetic material, known as a graft. Aortic aneurysm repair surgery is a major procedure having serious complications. It is considered only if minimally invasive treatment options are not possible or are ineffective.

Types:
The different types of aortic aneurysm repair surgeries are:

  1. Abdominal aortic aneurysm repair (AAA): This is the most common type of aortic aneurysm surgery that repairs an aortic aneurysm that occurs in the part of the aorta that is present in the abdomen (stomach). 
  2. Thoracic aortic aneurysm repair: This type of surgery is performed in that part of the aorta that is present in the chest.

The surgery can be performed in the following two ways:

  1. Open abdominal or open chest repair: This is the most common and most invasive type of surgery for repairing an aortic aneurysm. The surgeon replaces the weakened portion of the aorta with a graft made of a special fabric by making a cut on your chest or belly, depending on where the aneurysm is located.
  2. Endovascular repair: This procedure involves the insertion of a flexible wire frame that is sewed onto a special fabric tube called stent graft into the aorta by using a very thin tube known as a catheter.


Purpose:
The aortic aneurysm repair surgery is used for treating aortic aneurysm that can occur due to the following conditions:

  • Atherosclerosis (buildup of fat and cholesterol inside the arteries)
  • Smoking
  • Trauma
  • High blood pressure
  • Birth defects
Know More About Surgery

An aortic aneurysm repair surgery may be required if the aortic aneurysm causes the following symptoms:

  • Abdominal pain
  • Feeling of heartbeat in the abdomen
  • Lower back pain
  • Chest pain
  • Back pain
  • Jaw pain
  • Neck pain
  • Coughing
  • Hoarseness
  • Difficulty in breathing
  • Rapidly growing aortic aneurysm (approximately ¼ inch over the last 6 to 12 months)
  • Interference of blood flow to the other parts of the body, like the legs

If the aneurysm is larger than two inches : Aortic dissection (leaking of blood into the layers of the walls of the aorta) Rupture of aortic aneurysm, the symptoms of which are:

  1. Anxiety
  2. Pale and clammy skin
  3. Nausea
  4. Vomiting
  5. Dry mouth
  6. Excessive thirst
  7. Weakness
  8. Fainting
  9. Dizziness
  10. Sweating
  11. Rapid heartbeat

 

  1. Physical examination: The doctor will check you physically. Your medical history and family history are also noted.

  2. Chest x-ray: It is a medical test done to visualize the organs, bones, and other structures inside the chest.

  3. Blood tests: These tests help in evaluating the vital parameters of blood, and checking for any underlying medical conditions.

  4. Electrocardiogram (EKG): It is a painless test done to record the electrical activity of the heart, and diagnose any heart problems.

The procedure may be performed under general anesthesia (the patient is put to sleep during the procedure) or regional anesthesia (a nerve block that is given to numb a large area of the body) with sedation (to keep you comfortable and relaxed).
One of the following approaches can be used for an aortic aneurysm repair surgery:

1. Endovascular aortic aneurysm repair:

  • This procedure involves the insertion of a catheter and guide wire through an artery in the leg or groin region.
  • The tip of the catheter has a deflated synthetic graft.
  • This graft tends to expand like spring after the catheter is in place.
  • The walls of the aorta are reinforced by the synthetic graft.
  • The blood can now flow through the graft.
  • This surgery is less painful, has fewer complications, and has less recovery time than open surgery, due to less trauma to the organs and tissues.
  • If you are not a candidate for open surgery, this procedure may be performed. However, this procedure cannot repair all types of aneurysms.

2. Open surgery:

  • This procedure involves making a large cut or incision in the abdomen or chest area, depending on where the aneurysm is present.
  • The weakened part of the aorta is removed and replaced by a synthetic graft.
  • The doctor may also choose to cut open the aneurysm and place the graft inside.
  • This surgery allows the doctor to directly view and access the surgical area.
  • This procedure usually requires a longer recovery, an increased risk of complications, and more pain than an endovascular surgery.
  • An open surgery needs a larger incision and more cutting and displacement of the tissues, organs, and muscles than an endovascular surgery.
  • Open surgery is still considered to be a more effective and safer method for some patients.

The following risks are involved with an aortic aneurysm repair surgery:

  • Allergic reaction to anesthesia

  • Bleeding

  • Infection

  • Blood clot formation

  • Blockage of the graft

  • Damage to the blood vessel

  • Leaking of blood from the graft

  • Nerve damage

  • Bowel damage (if the procedure involves the abdomen)

  • Spinal cord injury

  • Sexual problems (in case of nerve injuries in the groin)

  • Pain or bloating in the abdomen

  • Breathing problems

  • Dizziness

  • Confusion

  • Chest pain or pressure

  • Coughing up green or yellow mucus

  • Coughing up blood

  • Fever

  • Inability to urinate

  • Inability to have a bowel movement

  • Leg pain, swelling, or redness

  • Pain that cannot be relieved using pain medications

  • Drainage of pus, redness, or swelling on the incision site

 

  1. The patient will be sent to the recovery room after the surgery and stay there till the vital signs are stable.

  2. The patient is then moved to an intensive care unit (ICU), which provides 24-hour monitoring and care.

  3. It may take a couple of hours for the anesthesia effect to wear off.

  4. A breathing tube may be given in your mouth which will not allow you to talk, but it is normally removed in a few days.

  5. It is normal to have a sore throat for a few days after the removal of the breathing tube.

  6. You may be shifted to a normal room from the ICU once you start recovering.

  7. You will be needed to stay in the hospital for two to five days after the endovascular procedure. 

  8. After open surgery, you may be required to stay in the hospital for seven to ten days.

  9. It is normal to have some pain and discomfort after the procedure.

  10. The doctor may prescribe pain killers to ease the pain and discomfort.

  11. The time of recovery depends on the type of procedure done, the age of the patient, the overall health status of the patient, and other factors.

  12. The doctor may recommend an exercise rehabilitation program for a quicker recovery.

  13. Follow all the diet, lifestyle, and activity restrictions that the doctor gives you.

  14. Inform your doctor if you notice any unusual symptoms after the procedure.

  15. Complete recovery may take two weeks to a couple of months.

  16. Follow-up visits and imaging tests are done to check the graft periodically.

  17. Additional procedures may be required in the future to maintain the graft.

Aortic Aneurysm Repair Cost in India

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Aortic Aneurysm Repair

A surgical procedure done to fix an aortic aneurysm is known as an aortic aneurysm repair surgery. An aortic aneurysm is a weakened area seen in the aorta, which is the main blood vessel or artery that leaves the heart and passes down the chest and abdomen (stomach region). 

The weakened part of the aorta can grow, stretch, and balloon outward with time. If the weakened area is left untreated, the aortic aneurysm can burst and cause heavy bleeding, which may be life-threatening. An aortic aneurysm repair surgery involves the removal or reinforcement of the diseased part of the aorta with a synthetic material, known as a graft. Aortic aneurysm repair surgery is a major procedure having serious complications. It is considered only if minimally invasive treatment options are not possible or are ineffective.

Types:
The different types of aortic aneurysm repair surgeries are:

  1. Abdominal aortic aneurysm repair (AAA): This is the most common type of aortic aneurysm surgery that repairs an aortic aneurysm that occurs in the part of the aorta that is present in the abdomen (stomach). 
  2. Thoracic aortic aneurysm repair: This type of surgery is performed in that part of the aorta that is present in the chest.

The surgery can be performed in the following two ways:

  1. Open abdominal or open chest repair: This is the most common and most invasive type of surgery for repairing an aortic aneurysm. The surgeon replaces the weakened portion of the aorta with a graft made of a special fabric by making a cut on your chest or belly, depending on where the aneurysm is located.
  2. Endovascular repair: This procedure involves the insertion of a flexible wire frame that is sewed onto a special fabric tube called stent graft into the aorta by using a very thin tube known as a catheter.


Purpose:
The aortic aneurysm repair surgery is used for treating aortic aneurysm that can occur due to the following conditions:

  • Atherosclerosis (buildup of fat and cholesterol inside the arteries)
  • Smoking
  • Trauma
  • High blood pressure
  • Birth defects

Symptoms

An aortic aneurysm repair surgery may be required if the aortic aneurysm causes the following symptoms:

  • Abdominal pain
  • Feeling of heartbeat in the abdomen
  • Lower back pain
  • Chest pain
  • Back pain
  • Jaw pain
  • Neck pain
  • Coughing
  • Hoarseness
  • Difficulty in breathing
  • Rapidly growing aortic aneurysm (approximately ¼ inch over the last 6 to 12 months)
  • Interference of blood flow to the other parts of the body, like the legs

If the aneurysm is larger than two inches : Aortic dissection (leaking of blood into the layers of the walls of the aorta) Rupture of aortic aneurysm, the symptoms of which are:

  1. Anxiety
  2. Pale and clammy skin
  3. Nausea
  4. Vomiting
  5. Dry mouth
  6. Excessive thirst
  7. Weakness
  8. Fainting
  9. Dizziness
  10. Sweating
  11. Rapid heartbeat

 

Diagnosis

  1. Physical examination: The doctor will check you physically. Your medical history and family history are also noted.

  2. Chest x-ray: It is a medical test done to visualize the organs, bones, and other structures inside the chest.

  3. Blood tests: These tests help in evaluating the vital parameters of blood, and checking for any underlying medical conditions.

  4. Electrocardiogram (EKG): It is a painless test done to record the electrical activity of the heart, and diagnose any heart problems.

Treatment

The procedure may be performed under general anesthesia (the patient is put to sleep during the procedure) or regional anesthesia (a nerve block that is given to numb a large area of the body) with sedation (to keep you comfortable and relaxed).
One of the following approaches can be used for an aortic aneurysm repair surgery:

1. Endovascular aortic aneurysm repair:

  • This procedure involves the insertion of a catheter and guide wire through an artery in the leg or groin region.
  • The tip of the catheter has a deflated synthetic graft.
  • This graft tends to expand like spring after the catheter is in place.
  • The walls of the aorta are reinforced by the synthetic graft.
  • The blood can now flow through the graft.
  • This surgery is less painful, has fewer complications, and has less recovery time than open surgery, due to less trauma to the organs and tissues.
  • If you are not a candidate for open surgery, this procedure may be performed. However, this procedure cannot repair all types of aneurysms.

2. Open surgery:

  • This procedure involves making a large cut or incision in the abdomen or chest area, depending on where the aneurysm is present.
  • The weakened part of the aorta is removed and replaced by a synthetic graft.
  • The doctor may also choose to cut open the aneurysm and place the graft inside.
  • This surgery allows the doctor to directly view and access the surgical area.
  • This procedure usually requires a longer recovery, an increased risk of complications, and more pain than an endovascular surgery.
  • An open surgery needs a larger incision and more cutting and displacement of the tissues, organs, and muscles than an endovascular surgery.
  • Open surgery is still considered to be a more effective and safer method for some patients.

Risks

The following risks are involved with an aortic aneurysm repair surgery:

  • Allergic reaction to anesthesia

  • Bleeding

  • Infection

  • Blood clot formation

  • Blockage of the graft

  • Damage to the blood vessel

  • Leaking of blood from the graft

  • Nerve damage

  • Bowel damage (if the procedure involves the abdomen)

  • Spinal cord injury

  • Sexual problems (in case of nerve injuries in the groin)

  • Pain or bloating in the abdomen

  • Breathing problems

  • Dizziness

  • Confusion

  • Chest pain or pressure

  • Coughing up green or yellow mucus

  • Coughing up blood

  • Fever

  • Inability to urinate

  • Inability to have a bowel movement

  • Leg pain, swelling, or redness

  • Pain that cannot be relieved using pain medications

  • Drainage of pus, redness, or swelling on the incision site

 

After Procedure

  1. The patient will be sent to the recovery room after the surgery and stay there till the vital signs are stable.

  2. The patient is then moved to an intensive care unit (ICU), which provides 24-hour monitoring and care.

  3. It may take a couple of hours for the anesthesia effect to wear off.

  4. A breathing tube may be given in your mouth which will not allow you to talk, but it is normally removed in a few days.

  5. It is normal to have a sore throat for a few days after the removal of the breathing tube.

  6. You may be shifted to a normal room from the ICU once you start recovering.

  7. You will be needed to stay in the hospital for two to five days after the endovascular procedure. 

  8. After open surgery, you may be required to stay in the hospital for seven to ten days.

  9. It is normal to have some pain and discomfort after the procedure.

  10. The doctor may prescribe pain killers to ease the pain and discomfort.

  11. The time of recovery depends on the type of procedure done, the age of the patient, the overall health status of the patient, and other factors.

  12. The doctor may recommend an exercise rehabilitation program for a quicker recovery.

  13. Follow all the diet, lifestyle, and activity restrictions that the doctor gives you.

  14. Inform your doctor if you notice any unusual symptoms after the procedure.

  15. Complete recovery may take two weeks to a couple of months.

  16. Follow-up visits and imaging tests are done to check the graft periodically.

  17. Additional procedures may be required in the future to maintain the graft.

FAQ Section

1) What is Aortic Aneurysm Repair Surgery ?

Aortic Aneurysm Repair is the surgery done to remove the aortic aneurysm , which is the bulge in the aorta ( major blood vessel of the heart ). This procedure is done either by open chest repair method or endovascular repair method.

2) What is an aortic aneurysm?

Aortic aneurysm is the bulge in the aorta, the main blood vessel of the heart. This happens when the artery wall becomes weak due to chronic illnesses. The blood flow force constantly pushes the weakened blood vessel walls, which makes them swell up. This leads to formation of balloon- like bulges called aneurysms. This bulge if becomes very large can burst, and lead to serious life threatening complications. 

3) What are the 2 types of Aortic Aneurysm Repair Surgeries?

The 2 types of Aortic aneurysm repair surgeries are- 

  • Open Abdominal or Open Chest repair surgery
  • Endovascular repair surgery

 

4) What is Endovascular Aortic Aneurysm Repair Surgery?

Endovascular Aortic Aneurysm Repair Surgery (EVAR) is the minimally invasive method to treat the aortic aneurysm. In this method instead of opening the chest or abdomen surgically using large incisions, in EVAR a small stent graft ( fabric tube with metal stents) is inserted into the aneurysm area via small cuts in the groin region. This method requires smaller incisions thus the recovery time is faster. 

5) What causes the aortic aneurysm?

The various causes that forms aortic aneurysm, which requires Aortic Aneurysm Repair Surgery are- Atherosclerosis ( hardening of the arteries ), high blood pressure, blood vessel diseases, infections of the aorta, or trauma to the aorta ( for example- car accident injury , etc ).

6) What are the tests done before Aortic Aneurysm Repair Surgery?

The tests done before Aortic Aneurysm Repair Surgery are-

  • Abdominal ultrasound- Common test done to diagnose, locate the abdominal aneurysms by passing sound waves to get the images.
  • Abdominal CT scan- Here X Rays are used to get cross sectional images of the aorta, site and size of the aneurysm, sometimes a contrast medium dye is injected into the vessels to get more clearer images. 
  • Abdominal MRI- Here magnetic fields and radio waves are used to get detailed images of the aorta structure, site and size of the aneurysm. 

7) What is Open Abdominal Aortic Aneurysm Repair Surgery?

In Open Abdominal Aortic Aneurysm Repair Surgery, a large incision is made in the upper abdomen or chest area, damaged part of the aorta is removed, and replaced with a graft that is stitched to the region. 

 

8) What is the cost of Aortic Aneurysm Repair Surgery in India?

 Cost of Aortic Aneurysm Repair Surgery in India varies across different cities and hospitals.

Cost of Aortic Aneurysm Repair Surgery in India
CITY COST
Cost of Aortic Aneurysm Repair Surgery in Mumbai INR 600000- INR 800000
Cost of Aortic Aneurysm Repair Surgery in Bangalore INR 580000- INR 780000
Cost of Aortic Aneurysm Repair Surgery in Delhi  INR 580000- INR 780000
Cost of Aortic Aneurysm Repair Surgery in Chennai INR 560000- INR 760000

 

9) What are the risks of Aortic Aneurysm Repair Surgery?

The risks of Aortic Aneurysm Repair Surgery can be divided as-

  1. Risks of Open repair surgery- heart attack, irregular heart rhythms, bleeding during and after the surgery, bowel vessels damage, blood clots, kidney failure, lung complications, spinal cord injury. 
  2. Risks of EVAR- Kidney damage, damage to surrounding blood vessels, groin wound infections, groin hematoma, bleeding, endoleaks, etc. 


 

10) When is Aortic Aneurysm Repair Surgery needed?

The Aortic Aneurysm Repair Surgery is needed for the following reasons- 
Prevent aorta rupture, relieve cardiac symptoms, restore good blood flow, when the aneurysm size is bigger than 5 cms, when the growth rate of aneurysm is > 0.5 cms per year, emergency life dangering bleeding.