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Outpatient Registration Hours

Mon-Thu: 8am-4:30pm
Fri & Sun: 8am-12:30pm

Pediatric Night Clinic Registration Hours

Mon-Thu: 7pm-8:30pm
Sun: 7pm-8:30pm

Visiting Hours

12pm-2pm
5pm-8:30pm

Address

465, Burma Road,
10350 Pulau Pinang,
Malaysia

Contact

Tel: (604) 222-7200
Fax: (604) 226-3366

Abdominal Aortic Aneurysm (AAA)

What is an Abdominal Aortic Aneurysm?

This is when a weakened part of a blood vessel expands like a balloon. An aneurysm in the largest blood vessel in your stomach area is called an abdominal aortic aneurysm (AAA).It can cause complications unless treated early.

Detecting an AAA

AAA often causes no symptoms in about 70%. It is often found when tests are done for an unrelated problem. Sometimes your doctor may find it while examining your abdomen.

Who Develops AAA?

Certain features increase your risk of having AAA

  • AAA runs in your family (positive family history)
  • Age - AAA is more likely as you get older
  • Factors such as smoking, having high blood pressure and a high
    • cholesterol level
  • Infection

AAA Management

Your vascular surgeon can discuss this treatment options with you and guide you through your choices. Your options depend on how large your aneurysm is. If an aneurysm gets large enough, it may burst.This can be very serious even fatal.Because a small aneurysm is not likely to burst, it may be watched for a while.When it reaches a certain size, you may have surgery to replace that section of your aorta.

Understanding AAA

Blood vessels are tubes that carry blood.The blood vessels that carry oxygen-rich blood from the heart to the rest of the body are called arteries.AAA affects the largest artery, the aorta. With AAA, part of the aorta weakens, expands and may eventually burst.

Evaluating Your AAA

Your aneurysm may have been noticed when you had a routine exam or a test for another problem.A complete exam and some tests are done to confirm AAA. Some of these tests also measure the size and growth of the aneurysm.

History and Physical Exam

Your doctor will take your medical history. He will also examine your heart, lung, abdomen and other systems to ensure your fitness for surgery.

Ultrasound

This uses sound waves to make images of your aorta and nearby blood vessels. The test allows the size of your aneurysm to be measured.The test is painless and does not take long. Lotion or gel is rubbed on the skin over your stomach. Next a sensor is moved back and forth over your abdomen.An image of your aorta can then be seen on a screen.

CT Scan/MRI

These show more details than an ultrasound. A CT scan (sometimes called CAT scan) takes a series of x-rays. These x-rays are put on a computer to form a picture of the aneurysm. Before the scan, you may be given a special dye. This dye makes your blood vessels show up better on the x-rays. An MRI also takes pictures.This test uses radio waves made by a strong magnet.These waves create images of your aorta.For this test, x-rays and dye are not used.

CT scan or MRI are especially important if endovascular stenting of the aorta are performed.

Arterial Doppler Study

An arterial doppler study measures blood flow in your legs. It is often used to gather more information about your arteries before surgery is done.

Angiography

Arteriogram creates an x-ray image arteriogram that shows the flow of blood through the aorta and the arteries that branch off of it. This test is often done if endovascular stenting of the aorta is performed. Like a CT scan, this test uses a special dye that makes your blood vessels show up clearly on the x-rays. Certain measurements of the diameter of the aorta and its branches are taken to help decide the size of the endovascular stent.

Monitoring Your Condition

The risk that a small aneurysm will burst is low. It may not grow, or it may grow slowly. You and your doctor may choose to monitor a small aneurysm for a while before deciding on surgery. This is known as watchful waiting. During this time, you may want to make some changes to improve your health.

  1. Follow-ups

    2. During watchful waiting, you may visit your doctor every 6 months or so. This visit includes an ultrasound or other tests.The test shows whether the aneurysm is growing and, if so, how quickly.If you feel intense pain in your back or stomach area, call your doctor right away.
  2. Making changes

    3. Certain changes will help improve your health and make your AAA less likely to grow. Changes include stopping smoking, controlling your blood pressure and eating the right foods.(see later).

If Surgery is Needed

  1. Preparing for Surgery
    • If you smoke, stop or cut down right away
    • Ask your doctor about donating your own blood ahead of time in case it is needed during your surgery
    • Tell your doctor what medications you are taking (including aspirin), and ask if you should stop taking them
    • DO not eat or drink anything (including water) after midnight the night before surgery
  2. Anaesthesia

    3. Anaesthesia is medication that prevents pain during surgery. The anaesthesiologist (doctor trained in anaesthesia) will likely tell you that you will have general anaesthesia. This makes you "sleep" during surgery. You may also have an epidural. For this, a thin soft tube delivers medication near your spinal cord. It may stay in for a day or so after surgery.
  3. Risks and Complications

    4. Surgery for AAA involves risks. However, these risks are usually outweighed by the risk of dying from a rupture. Risks include:
    • Infection
    • Kidney failure
    • Heart attack
    • Blood clots in the leg
    • Pneumonia
    • Stroke
    • Bleeding
    • Erectile dysfunction
    • Death

The Surgery

During surgery for AAA, the weakened aortic wall is replaced with a hollow artificial tube (a graft). The graft is usually made of strong fabric.

  1. Open Surgery for the Graft
    • An incision is made on the stomach area
    • The aneurysm is opened and cleared of any blood clot and fatty material
    • The best size graft is chosen
    • The wall of the aorta is wrapped around the graft to protect it
  2. Endovascular Aneurysm Stenting
    • A catheter with a small thin guide wire is passed into the groin artery, and guided into position of the aorta by an x-ray machine.
    • A balloon tipped catheter is inserted into the aorta, threaded over the guide wire and moved to the spot where the aneurysm begins to narrow (neck of aneurysm)
    • The balloon is inflated or deflated several times to crack the plaque and press in against the aneurysm neck
    • The stent is guided over the balloon
    • The balloon is inflated to impart the stent against the neck of the aneurysm.This step is then repeated in the reverse end of the aneurysm near the lower of the aorta or near the groin.
    • Stents can be placed in the groin arteries on both sides, if necessary

Recovering in the Hospital

After open surgery or endovascular stenting, you are taken to a special care unit where you are watched closely.Your hospital stay may be 5 days or more depending on the type of procedure.During this time, pain medications can help make you more comfortable.

  1. Immediately After Surgery
    2. When you first wake up you may have a tube to help you breathe.You may have a tube in your stomach to drain fluid.Another tube helps drain your bladder. For a few days intravenous lines provide fluids and medications. Monitors record your heartbeat and other vital signs.
  2. Managing Your Pain
    Pain medications are given initially via a special pump. If you were given an epidural, it may stay in place for a few days. Oral painkillers are started as soon as possible too. You will be helped to get up and move around. This improves muscle strength, breathing and blood flow.
  3. Going Home
    Before you go home the doctor will review the results of surgery with you. He will explain what to expect while you recover and what medications to continue on discharge.

Recovering at Home

Throughout your recovery, you will slowly gain energy and strength. Take things easy and rest when you get tired. Follow your doctors orders on what to do to help you get better.See your doctor for a scheduled follow-up visit.

  1. Caring for Your Incision
    Wash your incision gently when you take a bath. Pat it dry, do not rub. It is normal for your incision to be bruised and feel itchy, sore or numb for a few weeks.

  2. Taking Medications
    Take your pain medications as your doctor instructs. Do not wait until the pain gets bad before using them.You may also be given other medications. Take antibiotics as directed until the bottle is empty, unless your doctor tells you not to.

  3. When to Call Your Doctor or Casualty
    Call your doctor or come to the casualty if you have any of these symptoms or others that concern you:
    • A very red, very tender or draining incision
    • Fever over 100oF
    • Pain in your legs or abdomen

  4. Eating
    Start off with liquids and soup.As you feel better, slowly move on to more solid food.At first you may not feel like eating much. You may also have constipation or diarrhoea for a few weeks.

  5. Easing into Activity
    It takes 2-3 months or longer before your energy level gets back to normal.Avoid lifting anything heavy for at least 6 weeks to protect your healing incision.Ask your doctor about driving. You can have sex again when you feel ready.

  6. Notes to Family and Friends
    Your loved one may feel depressed or frustrated at times during her recovery.This is common.You might have similar feelings.Talk with each other about how you feel.

At first, your loved one will tire more easily than before surgery. This will slowly improve.Be patient and encouraging.