I.

Aneurysmectomy

What is Aneurysmectomy?

Aneurysmectomy is a surgical procedure performed to repair a weak area in the aorta. The aorta is the largest
Artery in the body and the main blood vessel leading away from the heart.

Demographics
An aortic aneurysm is a bulge in the wall of the aorta that is usually due to arteriosclerosis or atherosclerosis.
People who are 50 to 80 Years old are most likely to develop an aortic aneurysm, with men four times more likely to
develop one than women.

Purpose

The purpose of aneurysmectomy is to repair an aortic aneurysm that is likely to rupture if left in place.
Aneurysmectomyis indicated for an aortic aneurysm that grows to at least 2 in (5 cm) or for an aortic aneurysm of any
size that is symptomatic, tender, or enlarging rapidly.

Types of Aortic Aneurysms

Aneurysmectomy is performed to repair the two most common types of aortic aneurysms: abdominal aortic Ane
-urysms that occur in the abdomen below the kidneys, and thoracic aortic aneurysms that occur in the chest. It is major
surgery performed in a hospital under general anesthesia and involves removing debris and then implanting a flexible
tube (graft) to replace the enlarged artery. Aneurysmectomy for an aneurysm of the ascending aorta (the first part
of the aorta that travels upward from the heart) requires the use of a heart-lung machine that temporarily
stops the heart while the aneurysm is repaired. Aneurysmectomy requires a one-week hospital stay;
the recovery period is five weeks.

Preparation

Before elective aneurysmectomy:

Blood studies
chest x-ray
magnetic resonance imaging (MRI)
angiography
cardiac catherization
electrocardiogram (ECG) and
ultrasound

Aftercare
After aneurysmectomy, the patient is monitored in an Intensive Care Unit for the first 24-48 hours. Follow-
up tests include ECG, chest x-ray, and ultrasound.

Risks
Elective aneurysmectomy has a 5-10% rate of complications, such as bleeding, kidney failure, respiratory complications,
heart attack, stroke, infection, limb loss, bowel ischemia, and impotence. These complications are many times more
common in emergency aneurysmectomy.
II. Endarterectomy

What is Endarterectomy?
Endarterectomy is an operation to remove or by pass the fatty deposits, or blockage, in an artery narrowed by

the buildup of fatty tissue (atherosclerosis).

Purpose
Removing the fatty deposits restores normal blood flow to the part of the body supplied by the artery. An endar
terectomy is performed to treat cerebrovascular disease in which there is a serious reduction of blood supply to the
brain (Carotid endarterectomy), or to treat peripheral vascular disease (impaired blood supply to the legs).

Endarterectomy is most often performed on one of the two main arteries in the neck (the carotids) opening the
narrowed arteries leading to the brain. When performed by an experienced surgeon, the practice is extremely effective,
reducing the risk of stroke by up to 70%.

Precautions
Before the surgery, a full medical exam is usually done to assess any specific health problems, such as:

diabetes
highblood pressure
Heart disease or stroke.

If possible, reversible health problems, such as cigarette smoking or being overweight, should be corrected.

Preparation
Before surgery, the doctor pinpoints the location of the narrowed artery with an x-ray procedure called angio-
graphy. For surgery to be effective, the degree of narrowing should be at least 70%, but it should not be total. Patients
undergoing angiography are given a local anesthetia, but the endarterectomy itself requires the use of a general Anes-
thesia.

Aftercare
After the surgery, the patient spends the first two days lying flat in bed. Patients who have had carotid endarter-
ectomy should not bend the neck sharply during this time. Because the blood flow to the brain is now greatly
increased, patients may experience a brief but severe headache, or light headedness. There may be a slight loss of
sensation in the skin, or maybe a droop in the mouth, if any of the nerves in the neck were
lightly bruised during surgery. In time, this should correct itself.

Risks
The amount of risk depends on the hospital, the skill of the surgeon, and the severity of underlying disease. Patients
who have just had an acute stroke are at greatest risk. During carotid artery surgery, blood flow is interrupted
through the artery, so that paralysis and other stroke symptoms may occur. These may resolve
after surgery, or may result inpermanent stroke. Paralysis is usually ones-ided; other stroke symptoms may include loss
of half the field of vision, loss of sensation, double vision, speech problems, and personality changes. Risks of endarte-
rectomy to treat either carotidartery or peripheral vascular disease include:

reactions to anesthesia
bleeding
infection
blood clots