Aortic aneurysms occur 65 percent of the time in the abdomen, according to the Society of Thoracic Surgeons. Abdominal aortic aneurysms, called AAA, can be repaired by conventional surgery or endovascular surgery. In conventional surgery, the vascular surgeon makes an incision into the abdominal cavity to repair the aorta. Endovascular surgery, a less invasive procedure, involves insertion of a catheter through the groin to introduce a stent graft used to strengthen the arterial wall at the site of the aneurysm. Both procedures pose similar risks.
Blood Loss
"American Nurse Today" reported in 2009 that bleeding is a complication of AAA repair. In conventional surgery, bleeding occurs from incisions into the abdominal wall and aorta. Surgeons use heat, or cautery, pressure and clamps to control bleeding. Endovascular surgery places patients at risk for bleeding at the insertion site in the groin during the procedure and following removal of the catheter at the completion of surgery. The aorta can be damaged by the catheter or graft, causing bleeding. Patients remain at risk for bleeding for months after the endovascular surgery. Blood may seep around the graft into the aorta or into the abdominal cavity if the graft tears the artery wall.
Stroke
The Society of Thoracic Surgeons 2008 Endovascular Task Force reported an 8 percent risk of stroke during endovascular procedures to repair AAA. The task force suspects advanced patient age and poor health are factors. For this reason, endovascular surgery is reserved for younger patients.
Heart Attack
Low blood pressure during AAA surgery damages the heart. The elderly and patients with complicated health problems undergo conventional surgery procedures which take approximately three to four hours. The prolonged low blood pressure decreases the oxygen supply to the heart muscle. This factor combined with the more vulnerable health condition of the patients increases the risk of heart attack.
Paraplegia
The aorta is clamped during aortic aneurysm surgery which diminishes blood flow to the rest of the body. The spinal cord does not tolerate poor blood flow. Paralysis of the lower extremities may result.
Organ Ischemia
Another complication of abdominal aortic aneurysm surgery is diminished blood flow to the abdominal organs. A lack of oxygenated blood to the bowels and kidneys causes permanent damage. Death of tissue in the bowel leads to necrotic bowel and prolonged decreased perfusion of the kidneys results in kidney failure.
Wound Infection
The abdominal incision from a conventional surgery and the groin site for an endovascular procedure can become infected. Patients should observe for signs of infection such as redness, swelling, warmth and the presence of pus or purulent drainage from the wounds and report these symptoms to a doctor. Fever with or without signs of infection at the AAA surgical sites must be reported immediately because a systemic infection may develop which requires urgent medical care.
Pneumonia
In abdominal aortic aneurysm surgery, patients receive general anesthesia which requires the placement of a tube into the wind pipe to support breathing. This procedure exposes patients to organisms that cause lung infections such as pneumonia. Patients also have significant pain following surgery and do not take deep breaths. Shallow breathing increases the risk of pneumonia infection.
References
- Society of Thoracic Surgeons: Treatment of Descending Thoracic Aortic Disease; 2008
- "American Nurse Today"; Aortic Aneurysm: Causes, Clues, and Treatment Options; Marian Soat, MSN, CCRN; July/August 2009
