Quality of Life After Abdominal Aortic Aneurysm Surgery
During the treatment of an abdominal aortic aneurysm, a patient might experience certain limitations, both emotionally and physically. In addition, the patient might also face perioperative complications. If the patient experiences any complications, it is important to inform the physician in advance so that the doctor can perform appropriate treatment.
Emotional problems and limitations of lifestyle
Having your mitts firmly planted in the abdominal aorta can be a lonely task. Thankfully, the advent of robotics has alleviated many of the aforementioned hassles. Besides, who knows, maybe they can do it all for you! Nevertheless, one thing is for sure, a AAA surgery is a major life change for many men and women. Aside from the physical changes, you will also have to juggle with your emotions, which is not for the faint of heart. Having said that, the aforementioned complications should be considered as minor quibbles. To put the aforementioned challenges to rest, you might want to consider some form of cognitive augmentation. In the context of this study, cognitive enhancement could have been achieved by a plethora of interventions, such as tampering with the microbiome of your guts, a slew of supplements, or simply having a healthy and happy social network. If you are lucky enough to have a partner with similar sensibilities, you should probably consider taking up a philanthropic cause to help them out, because the odds of having a mate who isn’t is high.
Perioperative complications
Surgical intervention for abdominal aortic aneurysms is a major operation that involves major hemodynamic changes. Perioperative complications after aortic aneurysm surgery can result in adverse cardiovascular events. These can occur immediately after the procedure or may result from problems that are uncovered during the course of the procedure.
The most common postoperative cardiovascular complications are myocardial ischemia, acute hypotension, renal insufficiency, and multisystem organ failure. The incidence of perioperative myocardial ischemia is around three percent. It is characterized by an increase in cardiac troponin and a decrease in aortic blood flow. In the first 24 hours after surgery, the most likely cause of cTn elevation is acute thrombotic coronary occlusion.
Acute hypertension is often related to hypovolemia or sympathetic overactivity. It can also be a result of hypoxemia. These problems are generally not associated with the surgery itself but rather are caused by graft kinks or vascular stents. These problems can be corrected at the time of surgery, but they are unpredictable.
Endovascular aneurysm repair versus open repair
Elective abdominal aortic aneurysm repair (AAA) can be performed by open surgery or by endovascular means. The choice of treatment should be made on the basis of the patient’s anatomy and risk factors. Although the operative mortality and morbidity have been significantly reduced in endovascular aneurysm repair (EVAR), the long-term survival benefit has been limited.
In order to determine whether EVAR was superior to open abdominal aortic aneurysm surgery (AAA), investigators performed propensity score matching, a statistical method used to analyze data on similar populations. The propensity score was matched with Medicare beneficiaries. The matching was performed with medical records, which were then extracted and analyzed. The resultant database included 2852 patients. The patients were randomized into two groups: an EVAR group and an open repair group.
The EVAR group consisted of patients with aneurysm morphology and anatomical characteristics that are well suited to EVAR. The open repair group included patients who were anatomically suitable for EVAR, but who were deteriorating too rapidly to reach the operating room.
Society for Vascular Surgery practice guidelines
During the last two decades, endovascular abdominal aortic repair has become the most common treatment for abdominal aortic aneurysms. It is an alternative to open surgical repair that is associated with a decreased rate of perioperative morbidity. However, there are limitations to this approach.
Among the major issues related to EVAR is the risk of complications. These include graft migration, device rupture, endoleak, and aortic wall degeneration. These are relatively common post-procedure problems that require secondary intervention in up to 19% of patients.
The main determinants of success in an endovascular repair are the anatomic suitability of the patient’s vasculature, the aortic size, the extent of aortic dilatation, and the presence of an aortic sac. Therefore, the endograft must be of the right size for the patient’s anatomy and aortic morphology. The device must provide adequate seals at the landing zones, to prevent aneurysm sac formation.
The risk of perioperative complications and mortality is highest in older female patients, particularly those with cardiac disease or pulmonary disease. In addition, the 30-day mortality is significantly higher in women than in men.
