Endovascular AAA repair (EVAR)

You have an abdominal aortic aneurysm which is large enough to carry a real risk of rupture, which most people do not survive. Your surgeon has looke dat the options and after discussion with you, it has been decided that an endovascular or keyhole operation is the best way of treating this.

It will require a general anaesthetic, and then the surgeon will make an incision in your.

You should have already had most of the tests in order to make the decision about the best operation. We need a CT scan to see the anatomy of the aneurysm, and an exercise test of your heart and lungs (CPET or similar). There will be some last minute blood tests prior to surgery to make sure you are not anaemic and your kidneys are working well.

Even with the best preparation, some patients’ hearts may struggle with the stres of any operation, particularly if they have previous symptoms of angina or heart attack, or the operation is a long or difficult one. As a result, the main risk is of you having a heart attack, about 4%. Less commonly, the kidneys shut down temporarily due to changes in blood pressure or the dye used to check the operation, and a small number of patients (about 1%) need an artifical kidney for a few days. Some operations run into problems with bleeding, and this increases the risk of both kidney and heart complications, as well as the rare need for a second operation.

There are other risks associated with any general anaesthetic and any operation such as chest or wound infection, DVT, difficulty passing water postoperatively, but precautions are routinely taken for these.

The question most patients want answered is the risk of dying associated with the operation. This is about 2%, from all possible causes but predominantly heart problems. Your surgeon should discuss these risks with you in the clinci, particularly if your risks are above average, as well as reviewing them just before the operation.

You will be admitted the day before or on the day of surgery. You should not eat or drink from midnight on the day of the operation. You will be seen by the surgical team and sign the consent if not already done, and the anaesthetist will see you to explain about going off to sleep. The ward staff will help you change into a theatre gown, and you will be taken to the anaesthetic room in the theatre department. You will have a needle in the back of your hand and the anaesthetic team will put in other drips and monitoring including a urinary catheter.

After the operation you will go to the recovery suite, and remain there for a couple of hours until the team are happy to move you back to the ward. Some patients remain on the Extended Recovery Unit in the recovery bay overnight or occasionally the High Dependency Unit for closer monitoring.

You can eat and drink as soon as the surgical and anaesthetic team are happy that all is well postoperatively, usually within a couple of hours. The drips and catheter will be removed as you begin to mobilise, you will get a bit of discomfort and perhaps some bruising in the groins but you should be walking to the bathroom and around the ward the day after surgery and most people are ready to go home by about 4 days. Some patients get backaches after the operation, we think this is due to the aneurysm sac closing off. It usually settles after a couple of days and simple pain killers are effective.

You will feel a little tired and may get some discomfort in the groins but it should be only a couple of weeks before you are back to your usual level of activity. Take it steadily and don’t overdo it.

We will see you in the clinic at 6 weeks to check that you are pretty much back to normal, and the wound is healed well. About a quarter of patients are still on the mend at this stage, particularly patients over 75. With this operation, the chance of late complications is very small, and so we don’t routinely need to review you after this.