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Potential Complications of Aortic Aneurysm Surgery
Aortic aneurysm surgery is generally safe, but it can lead to complications like blood clots, ischemic events, and bleeding. Your doctor can give you a better idea of your specific risk of complications before your procedure.
An aortic aneurysm happens when an area of the aorta, the largest artery in the body, weakens and balloons out. It’s possible for an aortic aneurysm to come apart (dissect) or rupture, which can lead to life threatening bleeding in the body.
Sometimes, a doctor recommends surgery to repair an aneurysm to prevent a dissection or rupture. If an aneurysm has already dissected or ruptured, emergency surgery may be necessary to repair it.
As with any surgery, there are various risks and complications associated with aortic aneurysm surgery.
Potential complications after aortic aneurysm surgery
Generally, the risk of complications after an elective aortic aneurysm surgery that’s planned in advance is low.
Below, we briefly cover some of the potential complications of aortic aneurysm surgery, how common they are, why they happen, and how they can be treated.
Endoleak after aortic aneurysm surgery
Endoleaks are when blood finds a way around the graft, which is a tube that’s placed into the aorta to replace the area weakened by an aneurysm during your surgery.
When an endoleak occurs, your aneurysm is again at risk of rupturing. Endoleaks are estimated to happen in
of people having endovascular aneurysm repair (EVAR).
Some endoleaks can be monitored while others need treatment. Treatment depends on the type of leak that has occurred but typically involves another procedure.
Blood clots after aortic aneurysm surgery
Potentially serious blood clots can also form after aortic aneurysm surgery. These blood clots can:
Blood clots can block the flow of blood to the brain, heart, or lungs. This can lead to stroke, heart attack, or pulmonary embolism (PE), respectively.
Blood clots can also block blood flow to other areas, resulting in further complications related to ischemia.
A 2009 study found that 8.1% of people had DVT or PE after abdominal aortic aneurysm (AAA) surgery. A 2019 study found that 12% of people had a PE after EVAR.
Doctors may give you blood-thinning medications while you recover from surgery in the hospital to prevent clots from forming. Wearing compression stockings as you walk after surgery is another preventive measure.
Medication can treat blood clots to prevent new ones from forming or to break up the clot. Some need to be addressed via surgery to remove the clot.
Ischemia after aortic aneurysm surgery
Ischemia means that a part of your body is not receiving enough oxygen. When this happens, the tissue in the affected area can begin to die. There are different reasons that ischemia can occur after aortic aneurysm surgery.
For example, a blood clot that forms may block blood flow to an area. Additionally, aspects of the surgical procedure, such as misplacement of a graft, may interfere with blood flow.
A 2018 review of research notes that ischemic complications occur in about
of EVAR surgeries and at a higher rate in open surgeries, which are surgeries done via a large incision.
Ischemia due to aortic aneurysm surgery can affect several areas of the body and cause a variety of problems. Doctors treat it by restoring blood flow to the affected area, which may involve another procedure.
Surgery on a thoracic aortic aneurysm (TAA) can lead to upper limb ischemia. Surgery for an AAA can cause lower limb ischemia.
When a limb isn’t getting enough blood, it can lead to pain and eventually numbness and paralysis. If limb ischemia isn’t addressed promptly, amputation of the affected limb may be necessary.
Kidney ischemia can develop after surgery on an AAA. When the kidneys don’t get enough oxygen, it can lead to acute kidney failure.
Intestinal ischemia can happen after AAA surgery. It most often affects the colon and can lead to a condition called ischemic colitis.
Ischemia can also affect other pelvic tissues following AAA surgery. This can lead to a variety of health issues, such as erectile dysfunction and buttock claudication, which is pain in your buttocks that happens when you walk.
Spinal cord ischemia is more common after TAA surgery than after AAA surgery. It can lead to a variety of serious neurological problems, including:
Bleeding after aortic aneurysm surgery
Excessive bleeding is a potential complication of many surgery types. You may also see this referred to as “hemorrhage.”
A 2013 study found that 10% of people having elective AAA repair and 34% of people having EVAR for a ruptured AAA experienced excessive bleeding during the time around their surgery.
Blood transfusions can treat excessive bleeding. Additional medications or transfusion of other blood products, such as platelets, may also be used, if necessary.
Infections after aortic aneurysm surgery
Infections can also happen after aortic aneurysm surgery. When this happens, it typically affects the graft.
This type of infection happens in
of surgeries for AAA. Antibiotics and surgery to replace or bypass the graft can treat it.
Rarer complications after aortic aneurysm surgery
Several rare complications have been reported after aortic aneurysm surgery. Some examples include:
Aortic aneurysm surgery survival rate
The survival rate for elective aneurysm surgery is generally favorable.
A 2020 study including 738 people undergoing surgery for an ascending aortic aneurysm found that
(44 people) died in the period shortly after surgery.
Survival may also have improved over time. For example, a
of AAA surgery outcomes found that the 30-day mortality rate for non-ruptured AAAs decreased from 5.8% in 2001 to 1.7% in 2021.
Survival is less favorable for people having surgery for ruptured aneurysms. One 2020 study with 178 people having open surgery for a ruptured AAA found that
(95 people) died in the period shortly after surgery.
The risk of death depends on many factors, such as:
Life expectancy after aortic aneurysm repair
Life expectancy after aortic aneurysm surgery can vary based on several factors. Some of these include your age and overall health.
One 2019 study including people having either open surgery or EVAR found that the 10-year mortality rate was 38.1% for people under 70 years old and 80% for people over age 80. Long-term outlook was also better for people with fewer comorbidities, or coexisting conditions.
The type of procedure can also play a role. A
found that while open surgery had higher odds of 30-day mortality, it was associated with lower 6-year mortality, lower 6-year rupture, and lower future need to have the procedure again when compared with EVAR.
Life after aortic aneurysm surgery
Your care team will give you instructions related to activities when you return home from the hospital after your surgery. This includes things like when it’s OK to drive, return to work, exercise, and lift heavy things again.
Heavy lifting can increase blood pressure and negatively affect a recently repaired aorta. Be sure to follow their instructions carefully.
Blood pressure control is critical following this procedure. Maintaining a healthy blood pressure puts less stress on the aorta and the graft that was placed.
Many people who have aortic aneurysm surgery can go on to live a normal life. However, some may experience complications that require an additional procedure or will experience a rupture of their aneurysm.
Frequently asked questions about aortic aneurysm surgery
Here are some answers to frequently asked questions about aortic aneurysm surgery.
Ischemia can cause all the complications above. Ischemia is when a tissue isn’t getting enough oxygen. When this happens, tissue damage can occur. Ischemia can affect many parts of the body after aneurysm surgery, including the limbs, kidneys, digestive tract, and spinal cord.
Yes, it’s possible to live a normal life after aortic aneurysm repair. Some people may have complications that need to be addressed with additional medical procedures, while others may still experience the rupture of their aneurysm.
EVAR has a
long-term potential for future surgery and rupture rate than open surgery.
While you may do light exercise like short walks, it’s highly recommended to avoid strenuous activities or to lift heavy objects for at least 6 weeks after surgery.
Other activities that may be restricted include taking a bath, having sex, driving a car, and returning to work. Your doctor will give you specific guidance on when you can return to these activities.
Yes, but it typically depends on the aneurysm size and growth rate. Managing blood pressure and keeping it in a healthy range may treat small aortic aneurysms. It’s also important to refrain from smoking cigarettes.
By controlling these two risk factors, you and your doctor can attempt to keep the aneurysm from ever getting to a size that needs surgery. Once it gets large enough, surgery is the only way to repair the aneurysm.
If your doctor diagnoses an aortic aneurysm, they will monitor it periodically using imaging. If the aneurysm has become large or is growing quickly, they may recommend surgery.
Takeaway
Aortic aneurysm surgery is considered generally safe, but it is associated with risks and complications. Examples of some common risks include blood clots, ischemic complications, and excessive bleeding.
If your doctor recommends surgery for your aortic aneurysm, you can ask them about the risks associated with your procedure. Your outlook can depend on many factors, such as your age, overall health, and the type of surgery you have.
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