Consent: Open Repair of Abdominal Aortic Aneurysm

Note: This article is for educational purposes only. It should not be used as a template for consenting patients. The person obtaining consent should have clear knowledge of the procedure and the potential risks and complications. Always refer to your local or national guidelines.

Overview of Procedure

An open abdominal aortic aneurysm repair involves a laparotomy, dissection to the abdominal aorta, and clamping of the artery below the renal arteries, and in the iliac arteries.

The aneurysm is then opened, with the inferior mesenteric artery and lumbar arteries ligated, and either a tube or bifurcated graft sutured into the aorta to exclude the aneurysm.

The aneurysm sac and retroperitoneum are then sutured over the graft to reduce fistulae and infection rates, and the abdomen is closed.

Intra-Operative Complications

Complication Description Potential Reduction of Risk
Haemorrhage Particularly in the case of a ruptured AAA, the blood loss can be extensive, requiring use of a cell-saver machine as an absolute minimum, often also requiring blood transfusion(s).
Injury to surrounding structures including bowel, bladder and ureter The bowel must be moved aside to access the aorta, and, for patients with adhesions from previous surgery, this can be challenging. The ureter lies next to the iliac arteries and can be damaged if care is not taken. Decompress the bladder with a catheter
Anaesthetic Risks Includes damage to the teeth, throat and larynx, reaction to medications, nausea and vomiting, cardiovascular and respiratory complications. Forms a part of the anaesthetist assessment before the operation

Early Complications

Complication Description of Complication Potential Ways to Reduce Risk
Pain The patient will most likely have an epidural anaesthetic to minimise pain.
Bleeding There is a small chance of bleeding and bruising in the abdomen post-operatively.
Infection Superficial wound infection is possible, yet graft infections are also possible and are major complication that require life-long antibiotics and graft excision if possible. Peri-operative antibiotics will reduce the risk of wound and graft infections
Scarring A midline or transverse incision will result in a scar, which may form a keloid scar, particular in high risk ethnicities.
Seroma A swelling of lymphatic fluid may occur in the abdomen due to disruption of the lymph nodes and channels. Careful dissection of the lymphatic nodes and channels with ligation will minimise this risk.
Blood Clots DVTs and PEs are a possibility in any operation. The risk is increased in patients with a raised BMI, on the pill, recent flights, previous DVT, pregnancy, smokers, cancer and prolonged bed rest. The patient will be given anti-embolism stocking and low molecular weight heparin peri-operatively  to minimise this risk as deemed appropriate.
Bowel Ischaemia The inferior mesenteric artery is excluded during the procedure. Collateral circulation from the superior mesenteric artery and coeliac axis will usually prevent this complication, however in cases of SMA or coeliac stenosis, subsequent bowel ischaemia may occur.
Stroke, MI, Kidney Failure, Death Although small, this is always a risk in any major surgery

Late Complications

Complication Description Potential Reduction of Risk
Hernia Any laparotomy incision has the potential to cause a hernia in future. Avoid heavy lifting for 6 weeks post-surgery.
Adhesions Abdominal surgery may cause adhesions as a reaction to the procedure.
Graft occlusion A kink or narrowing in the graft can lead to occlusion and acute limb ischaemia, requiring thrombolysis, embolectomy, or placement of a new graft, however this is uncommon in open aneurysm surgery.
Impotence An alteration in the blood supply to the pelvis can cause impotence, as well as damage to the nerve which pass across the aortic bifurcation and are often cut
Reintervention The reintervention rate for open AAA repair is small compared to EVAR, but may occur due to any of the reasons outlined above.

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