WHAT HAPPENS BEFORE, DURING AND AFTER MY
ENDOLUMINAL SURGERY FOR AN ABDOMINAL AORTIC ANEURYSM

Dr. Alan Lossing

          B E F O R E

What exactly is an aneurysm?

An aneurysm is an enlargement or bulging of an artery. All artery walls are made up of 3 layers: outer, inner, and middle. The enlargement or bulging occurs at a weak area of the middle layer of an artery wall. 

Are there any signs and symptoms that you have an aneurysm?

Most aortic aneurysms have no symptoms at all, but sometimes abdominal pain will occur. Pain is caused by the aneurysm growing or bursting. If pain is present you should go to the emergency room of the hospital    IMMEDIATELY.

How dangerous are aneurysms?

The swelling is very dangerous and it can also burst causing severe life threatening internal bleeding and death. It can also disturb the blood flow in the aorta and cause particles (emboli) to break off and go to the legs or organs.

What is Endoluminal Surgery?

Endoluminal surgery is a type of procedure that can repair aneurysms without major surgery. The graft is placed into the aneurysm by using X-ray techniques to avoid a large abdominal incision. This procedure is new and the results are still early, therefore it is performed very selectively at the present time.

When is the surgery actually performed?

First, Dr. Lossing decides whether or not the aneurysm is large enough to warrant an operation by sending you for a series of x-rays. Usually when the aneurysm reaches 5 cm or above in diameter it is operated on to prevent rupture. After you have seen other specialists such as a cardiologist, an anesthesiologist and a radiologist, the team of doctors will decide whether or not you are eligible for this new procedure. All this will be done on an outpatient basis and may take from 4 to 6 weeks and then you will be back to see Dr. Lossing for a review before the final decision is made.

How is Endoluminal surgery performed?

The surgery is performed by inserting a compressed graft into the aorta through an incision (cut) in your right groin. Once the graft is in position, it expands to relieve pressure in the area affected by the aneurysm. A smaller graft is then inserted into your left groin and the procedure is repeated (Reference 1).

Are there any complications of this type of surgery?

The complications of this surgery are leaking around the graft once the graft has been put into place and dislodgement or migration of the graft, where the graft moves from where it was originally placed.

What are the benefits of this surgery?

The benefits of this surgery are that it is less traumatic on the heart, you are discharged from the hospital earlier (shorter hospital stay), less recovery time, and this procedure does not affect your bowel like the other surgery does.

What does the graft look like?

The graft is made of nitinol and it is 10 cm long and 2 cm in diameter. Nitinol is a compound that’s flaccid (lacking firmness) in cold temperatures, but quickly hardens into a solid at body temperature (Reference 2).

What happens to the bulge (aneurysm) once the graft is in place?

After the graft has been put in place the aneurysm does not go away, but it also does not get any larger and in some cases the aneurysm may even get smaller. (Reference 2)

Now that Dr. Lossing has given me a date for my endoluminal surgery, what happens next?

Now that you have a date for your surgery it is very important to remember to call the number listed in the pamphlet you were given, (416) 864-5736, on the weekday afternoon before your surgery between 12:30 and 2:30 p.m. You will then be told what time to arrive at the hospital the next day.

PLEASE READ THROUGH THE PAMPHLET AND REMEMBER THAT IT IS VERY IMPORTANT THAT YOU;

Do not eat or drink anything after midnight the night before your surgery.

Avoid smoking for at least 24 hours prior to your surgery.

Take a shower the morning of your surgery and do not wear any make-up, nailpolish or body lotions.

D U R I N G

When you arrive at the hospital, which will be the day of your surgery, go to the Admitting Department to register. The Admitting department will then direct you to the Sullivan Lounge on the 5^th floor.

A nurse will take your vital signs, blood pressure, temperature and pulse. You will be asked a series of questions and you will fill out a questionnaire. Then you will be given a short explanation of the procedure. It is okay to be nervous, in fact, it's normal.

Sometime before your surgery a nurse will come into your room and put a needle in your hand or arm. This is called an intravenous and it is used for medications.

Transportation personnel will come to take you to the radiology (X-ray) department. In the x-ray room on the table, the anaesthetist will put round sticky pads on your chest and hook wires to them. This is to monitor your heart. A blood pressure cuff will be put on your arm and you may feel a squeeze when your blood pressure is being taken. A clip will be put on your finger. This monitors your pulse throughout your surgery. The last thing is a blue square sticky pad that will be attached to your leg. This is for an instrument that will be used by Dr. Lossing. Before you go to sleep a needle MAY also be put into your back. This is called an epidural and it helps with pain management during and after your surgery.

Now you will go to sleep. The surgery will take approximately 3 to 4 hours and Dr. Lossing will speak to your family members after the operation in the reception area on the 5^th floor.

A F T E R  

After your surgery, you will be taken to the I.C.U. (Intensive Care Unit). You may not remember being transferred there but that is where you will wake up. When you wake up you will still be connected to a heart monitor to watch your blood pressure and pulse. You may also have more than one I.V. in your neck or other places besides the one in your hand before you went to sleep. You MAY also have a tube down your throat that will be taken out shortly after you arrive in I.C.U. This is called an endotrachial tube (breathing tube). The epidural that was put in before you went to sleep will also most likely still be in your back too. A catheter (tube) will also have been inserted to help you void (urinate).

You will also notice that you have bandages covering your groin area. This is the dressing that covers the staples that were put in after your surgery, this dressing will be taken off after you leave the Intensive Care Unit. You will probably stay in the Intensive Care Unit for 24 to 48 hours.

After you leave the Intensive Care Unit you will be transferred to the Vascular Floor in the hospital and you can expect to stay there anywhere from two to five days. During this time Dr. Lossing and his team will be taking care of you. They include; the senior fellow, surgery residents in Vascular Surgery, a Nurse Practitioner and other nursing staff on the Vascular floor. While on the floor most of the needles and tubes will be taken out. Once you are able to drink enough fluids, the intravenous in your arm or hand will come out. You will then be able to eat, as long as you are up to it. Once you are eating and walking again you will be discharged and asked to call and book a follow-up appointment to have your staples removed 7 to 10 days following your surgery at the Wellesley Site Vascular Clinic (416) 926-4826.

A F T E R  C A R E  Q U E S T I O N S

Will I have to take any medication when I get home from the hospital?

Before you leave the hospital you will be given a prescription for Tylenol #3. If you experience any pain you can fill this prescription. If you are allergic to codeine or Tylenol another medication will be used. If you were taking any other medications regularly before your surgery it is important to also resume taking these medications as well, unless otherwise instructed by your physician.

What about my staples?

Sometimes the staples are removed prior to discharge but if they are not you will be asked to book an appointment to see Dr. Lossing 1-2 weeks following your surgery, at the Wellesley Site Vascular Clinic (416) 926-4826. Dr. Lossing likes to see all his patients 1 to 2 weeks after their surgery for review and staple removal. It is also important to contact Dr. Lossing’s office at (416) 368-8886 to make follow-up appointments after your staples have been removed. You will have to come back for an appointment 1-month, 3 months, and 6 months after your surgery so that Dr. Lossing can make sure that everything is going fine with your recovery.

Can I take a shower or bath with my staples in?

You may have a shower or bath when you get home from the hospital, but remember that it should not be too hot, just warm water. Make sure not to soak the incision.

What about my diet? Will my diet ever get back to normal when I get home?

It is fine to resume your normal diet once you return home.

What are normal post-operative symptoms?

In general the following are normal:

1. General weakness is common.
2. Small amounts of discharge from your incision are normal.
3. Bruising around the incision is also very common.

When will I be able to travel in an airplane?

You can fly two or three weeks after your operation.

What about my activity level? Can I exercise?

It is important that you take it easy when you first get home from the hospital. REMEMBER you have had major surgery and it will take some time for your body to get back to normal. It is OK to resume your normal activities but do not overdo it and it is OK if you have to take a few breaks in between; light activity is permitted. It is important that you discuss your activity level with Dr. Lossing, so he can determine whether or not you are doing too much.

What about lifting? How much can I do?

It is essential that you do not do any heavy lifting for at least six to eight weeks after your surgery. Do not lift anything larger than the telephone book.

Can I drive my car or any other motor vehicle?

You should not drive until you have spoken to Dr. Lossing in your follow-up visit at the Vascular Clinic. Therefore, someone should come to the hospital to pick you up when it is time to leave.

When can I go back to work?

Every patient is different but do not go back to work until you have discussed it with Dr. Lossing. At your follow-up visits Dr. Lossing will decide with you when it is appropriate for you to go back to work.

What about the forms for work?

Please bring any forms to the follow-up appointment in the clinic with the date of your surgery and how long you stayed in the hospital filled in and Dr. Lossing will fill in the rest.

What if I am worried about anything that is not covered in this booklet?

If you are worried about anything that is not covered in this booklet, feel free to contact Dr. Lossing at (416) 368-8886 at any time with your concerns.