Aortic Reconstruction
 What are Aortic Aneurysms?
An aortic aneurysm is an abnormal bulge in the wall of the aorta, the body's largest artery (the blood vessel that carries oxygen-rich blood). Roughly the diameter of a garden hose, this artery extends from the heart down through the chest and abdominal region, where it divides into a blood vessel that supplies each leg. Although an aneurysm can develop anywhere along your aorta, most occur in the section running through your abdomen (abdominal aneurysms). The rest occur in the section that runs through your chest (thoracic aneurysms).
The weakened artery wall may stretch as blood is pumped through it from the heart. In general, if the diameter of the aneurysm is more than 1.5 times the size of the normal aorta, it is called an aneurysm.
An aortic aneurysm is serious because - depending on its size - it may rupture, causing life-threatening internal bleeding. The risk of an aneurysm rupturing increases as the aneurysm gets larger. The risk of rupture also depends on the location of the aneurysm. When detected in time, an aortic aneurysm can usually be repaired with surgery.
 What is an Aortic Dissection?
The aorta is composed of three layers. Aortic dissections occur when the layers separate (the way plywood will separate if left out in the rain). When dissections occur, patients typically experience severe pain in the chest or back which may be described as tearing discomfort. This most frequently takes them to the emergency room, where the diagnosis may be made.
Dissections may occur any place along the aorta and treatment depends upon the location. Frequently, those involving the part of the aorta where it leaves the heart are treated with emergency surgery while those involving the lower thoracic (chest) aorta are treated with medication. Although dissections are uncommon, they are the most common of the emergency aortic surgery.
How is Aortic Disease Treated?
Treatment for an aneurysm depends on its size and location and your general health. If the aneurysm is small and you have no symptoms, your physician may suggest a "watch-and-wait" approach with regularly scheduled images of the aneurysm to check the size. However, if your aneurysm is large enough, or if the aneurysm is growing more than 1 centimeter (cm) per year, surgery may be your best option. Your health-care provider will work with you to evaluate the risks of rupture and the risks of surgery.
If an aortic dissection is present, this often requires emergency surgery to repair the problem.
 Aortic Reconstruction Surgery
The accepted standard treatment for aneurysm once it meets the indications for surgery is replacement of that portion of the aorta with an artificial graft. Typically a graft is made from Dacron, a material that will not wear out. The graft is sewn in place with a permanent suture material. Sometimes a graft with a valve is used to replace the section of aorta if the aortic valve is involved. In this case, the replacement is done with donated tissue.
The operation, including the incision that is made, depends on the location of the aneurysm. If the aneurysm is close to the aortic valve, an incision in the front of the chest such as a down the length of the breastbone may be used. If the aneurysm is close to the valve, the aortic valve may have to be repaired or replace at the same time of the surgery. Surgery on the aortic arch is usually done from the front as well. If the aneurysm involves the descending thoracic aorta, which lies in the left chest, or the thoracic abdominal aorta, an incision on the left side of the chest will likely be required.
What happens right after the procedure?
After surgery, the person is taken right away to the intensive care unit, or ICU. He or she will be given medication for the first few hours to make him or her sleep. When the person awakens, he or she should not be alarmed to find:
- a breathing tube, called an endotracheal tube, down the windpipe. This tube is attached to a ventilator, or artificial breathing machine, to ensure deep breaths and to make it easier for the person to breath. This will usually be removed on the same day as surgery, when he or she is awade, and able to take deep breaths.
- a stomach tube, called a nasogastric tube, in the nose to drain the stomach and prevent nausea and stomach swelling
- a narrow tube, called a urinary catheter, in the bladder to measure the amount of the urine the body is making.
- one or two tubes in the chest to drain fluid from around the heart. many intravenous, or IV, lines to give fluids, medications and blood as needed
- a small tube in the wrist to monitor blood press ure closely
- a tube in the neck to monitor how well the heart is pumping and to allow an easy, painless way to draw blood
The person will be given pain medication as needed.
On the first day after surgery, many of the tubes will be removed. The person may be transferred to the step down unit, or telemetry unit, if there have been no problems. In the telemetry unit the person will:
- be asked to breath deeply and cough often to prevent pneumonia
- be encouraged to sit at the edge of the bed and dangle his or her feet
- have the chest tube and urinary catheter removed
- eat, if possible, starting with clear liquids
- be given pain medication if it is needed
- begin walking the day after surgery. This will help to prevent blood clots from forming, and reduce ankle swelling.
The average hospital stay following
aortic reconstruction
is 5 to 7 days.
What happens later at home?
The recovery time at home will last for about 6 weeks. During this time, the incision will heal slowly, with some redness, tenderness and swelling present for several months. The person will be advised to:
- have a check-up with the surgeon about 10 to 14 days after the surgery
- take showers instead of baths for 4 to 6 weeks until incision is completly healed.
- begin a walking program
- avoid lifting and straining for 4 to 6 weeks
- not drive for 4 to 6 weeks
- resume sexual activity as desired after the first check-up with the surgeon
- rest twice a day for the first few weeks, and get 8 to 10 hours of sleep at night
- expect some constipation if pain medication has been used often, eating extra fruits and vegetables can be helpful to prevent constipation.
This is a good time for a person to start thinking about changing his or her lifestyle and addressing any coronary risk factors that may have contributed to his or her heart problem. For instance, a person should:
- quit smoking if he or she smokes. Smoking after heart bypass surgery increases the risk of the bypass artery clogging again.
- control his or her blood pressure. If medication is prescribed, it should be taken as directed.
- follow a diet low in fat, cholesterol, and sodium.
- lose weight, if needed
- walk or do other exercise each day
What are the potential complications after the procedure?
All major surgery carries the risk of bleeding, infection and death. After aortic surgery, irregular heart rhythms, know as arrhythmias may occur. If lifestyle changes aren’t made, the new grafts may block. Incision and chest muscle pain may last for months. Some numbness in the skin near the incision may also occur. However, this problem often gets better over time.
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