Form: D-5901 Open Repair of Your Aortic Aneurysm Information for patients who are preparing for surgery This guide gives you important information about: • your aneurysm and its repair • what to expect before, during and after surgery • what you can do to have a healthy recovery • your need for follow-up care Your name: Your Vascular Surgeon: Your Pre-admission visit date: Date of surgery: We welcome your questions at any time. Please tell us your needs and preferences, so that we can better care for you and your family. Our goal is to make your ‘journey’ as smooth as possible. This booklet is for information only. It does not replace the advice of your surgeon and health care team. Table of contents Topic Page Aortic aneurysms 2 Open aortic aneurysm repair 5 Pre-admission clinic visit 6 Preparing for surgery 8 The day of surgery 10 What happens after surgery 11 Going home from the hospital 17 Your recovery at home 17 When to get medical help 21 Important contact information 22 1 Aortic Aneurysms What is the aorta? The aorta is the largest blood vessel in your body (about 2 cm wide). The aorta carries oxygen-rich blood from your heart to all parts of your body. • Your aorta runs through your chest and abdomen. The part in your chest is called the thoracic aorta. The part in your abdomen is called the abdominal aorta. • In your lower abdomen, the aorta splits into two smaller blood vessels (iliac arteries) that carry blood to your legs. What is an aortic aneurysm? An aneurysm is a bulge, or balloon-like swelling, on the wall of a blood vessel. When this is found on the aorta, it is called an aortic aneurysm. An aneurysm is diagnosed when the aorta widens by more than 3 cm. Aneurysms are most commonly the result of degenerative aortic disease. Most people do not know that they have an aneurysm. Aortic aneurysms are called ‘silent’ because they rarely cause any symptoms until they rupture. Most are found during tests (such as ultrasound, CT scan or MRI) that are done for other reasons. We recommend that your close relatives be tested for aneurysms. 2 Aneurysms are named based on their location in your body: • If the aortic aneurysm is in your chest, it is called a Thoracic Aortic Aneurysm (TAA). • If the aortic aneurysm is in your abdomen, it is called an Abdominal Aortic Aneurysm (AAA). • If the aortic aneurysm begins in your chest and continues into your abdomen, it is called a Thoraco-Abdominal Aortic Aneurysm (TAAA). • If the aortic aneurysm is in iliac arteries it is called an Aortic Iliac Aneurysm. Why is an aortic aneurysm dangerous? An aortic aneurysm can be dangerous because the walls of the aorta may get so weak or thin that they burst (rupture) and bleed. A ruptured aneurysm causes serious internal bleeding, which can cause death quickly without proper treatment. If your aneurysm ruptures, you will have one or both of these symptoms: • New and persistent pain in your chest, back, abdomen or groins • Feeling dizzy or faint As you wait for your surgery: • If you have either of these symptoms, call 911 or go to your nearest hospital Emergency Room. • Avoid strenuous activities such as heavy lifting. Do not lift anything heavier than 20 kilograms (45 pounds). 3 Factors that can increase your chance of developing an aneurysm: • Smoking (now or in the past) Aneurysms are • Getting older most common in men and older adults. • High blood pressure (hypertension) • Having a connective tissue disorder such as Marfan syndrome • Injury (trauma) • Other members of your family have had an aneurysm When is an aortic aneurysm treated? Aneurysms usually widen or ‘grow’ slowly, about 2 to 4 mm a year. When the abdominal aorta reaches a certain size (5.5 cm in men or 5.0 cm in women) your surgeon may recommend surgery to repair the aneurysm. Aneurysms that grow quickly (over 1 cm in a year) are more likely to rupture and may need to be repaired sooner. How can aortic aneurysm be treated? Aortic aneurysms can be treated with open repair or by endovascular stent graft (EVAR). Your surgeon recommended open repair after carefully considering your age, health, as well as the size, location and shape of your aneurysm. Your surgeon will explain in detail the benefits and risks of each repair. 4 Open Aortic Aneurysm Repair During an open repair, the surgical team: • makes an incision in the abdomen and at times in the groins • gives you an anticoagulant (blood thinning medication) and then stops the blood flow through the aorta • opens the section of the aorta affected by the aneurysm • sews a durable, fabric tube (graft) into place, connecting the healthy ends of the aorta What tests will I need to have? Before your surgery, you may have: • A CT scan or an MRI. These tests give your surgeon detailed images of your arteries and adjacent structures. • Heart tests to see if your heart is strong enough for the surgery • Blood tests • A chest x-ray • An ECG What type of anesthetic is used? An anesthetic is a medication that reduces or prevents pain. Before surgery, you will meet with a doctor (Anesthesiologist) who will provide more details. You will receive a general anesthetic. It makes you sleep during surgery and feel nothing. When you are asleep, the doctor will insert a breathing tube in your throat. An epidural catheter may also be inserted at the start of the surgery to help with any pain you have after the surgery. 5 What are the risks and possible complications of open surgery? As with any surgery, there are some risks. Your surgeon will discuss risks that are specific to you before your surgery. Some risks may include: • heart attack • stroke • kidney failure • wound infection • bleeding • spinal cord damage (paralysis) • bowel ischemia • death Your Pre-Admission Clinic visit You will need to visit the Pre-Admission Clinic unless you are going to be admitted to the hospital before your surgery. Your visit will be about 2 weeks before surgery date and may take from 3 hours up to the entire day, depending on your needs. A family member or friend is welcome to come with you. If your appointment is less than 1 week before your surgery and you are taking blood thinning medication, please tell your surgeon’s office. You may need to stop taking blood thinners about 5 days before your surgery. Unless you are given other instructions, you must come to your Pre-Admission Clinic visit or your surgery may be canceled. The Pre-Admission Clinic is located at Toronto General Hospital, 200 Elizabeth Street, ground floor – Room 400 Eaton Building (Eaton entrance). If you cannot come to this visit, call 416 340 4800 ext. 3529 to reschedule. You cannot have surgery without a pre-admission visit. 6 What to bring to your pre-admission visit: … Ontario health card (OHIP) … Extended health insurance information, if you have it … Contact information for your family doctor and pharmacy … Your ‘History and Physical’ form, filled out by your family doctor … All the medications you take in their original containers. This includes prescription medications, over-the-counter medicines, vitamins, supplements and herbal or ‘natural’ products. … Copy of your power of attorney for personal care and/or advanced directives On the day of your Pre-Admission visit, take your medications and eat as usual, unless you were given other instructions. What happens at your Pre-Admission Clinic visit? During this visit: • You will fill out paperwork so you can be admitted to hospital. • You may have tests, including blood tests, a chest x-ray and an electrocardiogram (ECG) to check your heart. • A nurse will ask you questions about your health and help you prepare for surgery and recovery at home. You will learn how to do deep breathing and coughing exercises that keep your lungs clear and prevent infection (such as pneumonia) after surgery. • The nurse will tell you when to stop eating and drinking before surgery. Usually you will have nothing to eat after midnight before surgery. • A nurse or pharmacist will review your medications. They will tell you which medications to stop before surgery, and which to take on the morning of your surgery with a sip of water. 7 Preparing for your surgery Make plans for coming home after surgery • Arrange for someone to take you home from the hospital on the day you expect to leave. You will not be allowed to go home by yourself after your surgery. • If you live alone, plan for someone to stay and help you for at least a few days. You may need help with groceries, cooking, laundry, cleaning and rides to medical appointments. • Make or buy extra meals and freeze meals that will be easy to reheat. Quit smoking Stop smoking – for safer surgery, a faster recovery and better health • Smoking harms your body. Smokers often have more heart and breathing problems after surgery. • If you quit smoking before your surgery, you may have fewer heart and breathing problems, and heal faster after surgery. • It is hard to quit smoking, but help is available! Talk to your Time to be doctor about programs and products that can help you quit. smoke free! • Visit Smoking Cessation at UHN (https://www.uhn.ca/ corporate/AboutUHN/Smoking_Cessation) for helpful information and resources. Make arrangements for out-of-town family • For a list of places to stay near the hospital, visit www.uhn.ca and click on ‘Patients and Families’, ‘Patient Services’ and ‘Accommodations and places to stay’. Some places offer a discounted ‘hospital rate’. 8 The day before your surgery Follow all the instructions you were given at your pre-admission visit. • Do not smoke or drink alcohol for 24 hours before your surgery. • Remove your nail polish, jewelry and any body piercing. • Make sure you take all medications you were told to with sips of water. Do not eat or drink ANYTHING after midnight the night before surgery. Do not chew gum. Your surgery may be cancelled if your stomach is not empty. What to bring to the hospital: … Ontario health card (OHIP) and any other extended health insurance information, if you have it … All the medications you take in their original containers. This includes prescription medications, over-the-counter medicines, vitamins, supplements and herbal or ‘natural’ products that you buy without a prescription. … Enough comfortable clothes for several days, plus non-slip shoes or slippers. … Personal care items such as a toothbrush, toothpaste, soap and deodorant. Do not bring scented products such as perfume or cologne. … Hearing aids, dentures and glasses in their protective cases, labelled with your name. You are responsible for your belongings. Please do not bring jewelry or anything valuable. 9