aneurysmectomy


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Related to aneurysmectomy: angiospasm, aneurysmorrhaphy, arteriorrhexis

Aneurysmectomy

 

Definition

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.

Purpose

The purpose of aneurysmectomy is to repair an aortic aneurysm that is likely to rupture if left in place. Aneurysmectomy is 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.

Precautions

Aneurysmectomy may not be appropriate for patients with severely debilitating diseases such as cancer, emphysema, and heart failure.

Description

An aortic aneurysm is a bulge in the wall of the aorta that is usually due to arteriosclerosis or atherosclerosis. People who are 50-80 years old are most likely to develop an aortic aneurysm, with men four times more likely to develop one than women.
An aortic aneurysm develops and grows slowly. It rarely produces symptoms and is usually only diagnosed by accident during a routine physical exam or on an x ray or ultrasound done for another reason. As the aneurysm grows larger, the risk of bursting with no warning, which causes catastrophic bleeding, rises. A ruptured aortic aneurysm can cause sudden loss of a fatal amount of blood within minutes or it can leak in a series of small bleeds that lead within hours or days to massive bleeding. A leaking aortic aneurysm that is not treated is always fatal.
Aneurysmectomy is performed to repair the two most common types of aortic aneurysms: abdominal aortic aneurysms 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.

Key terms

Aneurysm — A weakening in the muscular walls of a part of the artery which causes the damaged section to enlarge or sag, giving it a balloon-like appearance.
Aorta — The main blood vessel that leads away from the heart and the body's largest artery. The aorta carries blood from the heart through the chest and abdomen, providing major branches to all of the organs in the body.
Arteriosclerosis — Hardening of the arteries that occurs as part of the aging process.
Artery — A blood vessel that carries blood from the heart to the body's tissues.
Atherosclerosis — A form of arteriosclerosis in which cholesterol-containing fatty deposits accumulate in the inner most walls of the heart's arteries.
Thoracic — Relating to the chest.
During surgery, the site of the aneurysm (either the abdomen or the chest) is opened with an incision to expose the aneurysm. The aorta is clamped above and below the aneurysm to stop the flow of blood. Then, an incision is made in the aneurysm. An artificial Dacron tube is sewn in place above and below the opened aneurysm, but the aneurysm is not removed. Plaque or clotted blood are cleaned from the diseased tissue. The clamps are removed and blood flow is reestablished through the graft. The wall of the aneurysm is wrapped around the graft to protect it and the skin of the abdomen or chest is sewn up.
Aneurysmectomy can be performed as elective or emergency surgery. Elective aneurysmectomy takes about an hour and is far safer than emergency aneurysmectomy, with a mortality rate of 3-5% for elective abdominal aneurysmectomy and 5-10% for elective thoracic aneurysmectomy. When an aneurysm ruptures, 62% of patients die before they reach the hospital. Of those who make it into emergency aneurysmectromy, 50% die. After a successful aneurysmectomy, the patient has nearly the same life expectancy as other people of the same age.

Preparation

Before elective aneurysmectomy, blood studies, a chest x ray, cardiac catherization, electrocardiogram (ECG), and ultrasound are performed.

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.

Resources

Periodicals

Donaldson, M. C., M. Belkin, and A. D. Whittemore. "Mesenteric Revascularization During Aneurysmectomy." Surgery Clinic of North America 77 (April 1997): 443-459.

aneurysmectomy

 [an″u-riz-mek´to-me]
surgical excision of an aneurysm.

an·eu·rys·mec·to·my

(an'yū-riz-mek'tō-mē),
Excision of an aneurysm.
[aneurysm + G. ektomē, excision]

aneurysmectomy

(ăn′yə-rĭz-mĕk′tə-mē)
n.
Excision of an aneurysm.

aneurysmectomy

Surgery The surgical removal of an aneurysm, see there.

an·eu·rys·mec·to·my

(an'yūr-iz-mek'tŏ-mē)
Excision of an aneurysm.
[aneurysm + G. ektomē, excision]
References in periodicals archive ?
Keywords: Aneurysmectomy, Concomitant valve replacement, Internal mammary, Literature, Saphenous vein.
Partial aneurysmectomy for salvage of autogenous arteriovenous fstula with complicated venous aneurysms.
However, according to a review based on several case reports, aneurysmectomy with aggressive debridement is reported as having a survival rate that is falsely high [11].
Of three patients (cases 11, 13, and 14) with apical ventricular aneurysm, two patients (cases 11 and 14) with no viable myocardium in the area of aneurysm had concomitant aneurysmectomy and one patient (case 13) with some viable myocardium in the area of aneurysm recovered well without aneurysmectomy.
This study selected the following elective procedures, as they were frequently performed and often involved a request for blood products: right and left hemicolectomy (COLE) for colonic cancer, coronary artery bypass graft (CABG), unilateral total hip replacement (THR), abdominal aorta aneurysmectomy (AAA), laparoscopic cholecystectomy (CHOLE), and transurethral prostatectomy (TURP).
Effects of isovolemic hemodilution on abdominal aortic aneurysmectomy in high risk patients.
Kretzschmar et al., (10) also had observed this similar response in their study on the effect of NAC in ischemia-reperfusion syndrome in patients undergoing abdominal aortic aneurysmectomy.
Off-pump coronary artery bypass grafting (Off-pump CABG) was performed in 43 (29.2%) patients; CABG with conversion to cardiopulmonary bypass (CPB) after starting off-pump was carried out in 37 (25%) patients; CABG with CPB was performed in 58 (39.4%) and CABG + left ventricular aneurysmectomy was performed in 9 (6.1%) (Table-2).
The patient was operated upon and the sewing needle was removed (Figure 5) along with aneurysmectomy followed by PTFE graft repair.
Traditionally, bipolar surgical ligation of the splenic artery, ligation of the aneurysm, or aneurysmectomy with or without splenectomy was the lifesaving and mandatory procedures for splenic hemangioma, with a mortality rate of approximately 1%.
Left ventricular aneurysmectomy to treat drug-resistant VT was described in 1959 by Couch [2].
* surgery (lymphadenectomy, colectomy, aortic aneurysmectomy)