The aorta is the main blood vessel supplying blood to the entire body; the abdominal aorta is the part of the aorta that passes through the abdominal cavity. Surgical repair of the abdominal aorta can be done through an incision in the abdomen, called an open abdominal aortic surgery, or with placement of a tube in the abdominal aorta through catheters inserted through an artery in the leg, called an endovascular abdominal aortic operation. According to Brustia and colleagues in the February 2007 issue of "Interactive Cardiovascular and Thoracic Surgery," the incidence of death from complications after an abdominal aorta surgery is as high as 50 percent in open abdominal procedures, with a reduced risk in catheter procedures. Elective surgery has a lower risk than an emergency operation.
Blood Clots
Blood clots in the vessels of the lower extremities or pelvis, called deep venous thrombosis, are a possible complication after most surgeries. Dr. Mohamed Bani-Hani reported in a 2009 study that the incidence of deep venous thrombosis in abdominal aortic surgery ranges from 2 to 18 percent, but there is little evidence to support the use of blood-thinning medications in these operations, particularly in light of the risk of bleeding with such drugs. Early mobilization after surgery is important in preventing blood clots, along with the use of compressive stockings or devices.
Infections
An August 2009 article at Hospitalist News reported the infection complication rate in 870,788 patients who had undergone open abdominal aortic surgeries was over 11 percent, with a 2.8 percent rate for endovascular aortic procedures. Infections included urinary tract infections, pneumonia and sepsis, as well as infections of the surgical site, and were highest in large, urban or teaching hospitals. More women than men experienced infectious complications, and they were more common in the elderly.
Gastrointestinal Complications
Gastrointestinal complications occur in open abdominal aortic surgeries in about 8.6 percent of cases and include bleeding, necrosis of the bowel and loss of bowel contractions, called an ileus, according to Alpagut and associates in the March 2003 issue of "Asian Cardiovascular and Thoracic Annals." Because the abdominal contents are not manipulated in endovascular abdominal aortic procedures, gastrointestinal complications are less frequent, although occasionally there is bleeding into the space behind the abdominal contents, termed the retroperitoneal space. Mortality from gastrointestinal complications can be as high as 67 percent and often a surgical operation is required to repair the complication.
Postoperative Aneurysms
Open abdominal aortic surgery for an aortic aneurysm requires reconstruction of the aorta by removing the aneurysm and then connecting the rest of the aorta together, called anastomosis, often with grafting material. Dr. El Sakka and colleagues reported in a February 2008 article in "Interactive Cardiovascular and Thoracic Surgery" that a relatively frequent complication in this operation is formation of an aneurysm at the anastomosis site, which occurs in up to 15 percent of cases. Such an aneurysm may rupture and death occurs in a majority of ruptures because of massive hemorrhage. Early diagnosis is important and, when detected, can often be repaired with an endovascular procedure.
References
- "Interactive Cardiovascular and Thoracic Surgery": Fast-Track Approach in Abdominal Aorta Surgery--Left Subcostal Incision With Blended Anesthesia
- The Cochrane Library: Interventions for Preventing Venous Thromboembolism Following Abdominal Aortic Surgery
- Hospitalist News: Infection Rate Exceeds 11% After Open Abdominal Aortic Surgery
- "Asian Cardiovascular and Thoracic Annals": Gastrointestinal Complications After Transperitoneal Abdominal Aortic Surgery
- "Interactive Cardiovascular and Thoracic Surgery": Complications of Open Abdominal Aortic Surgery--The Endovascular Solution
