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My EVAR (keyhole) operation

When do I come into hospital?

What happens when I am admitted?

What are the risks involved?

What happens on the day of the procedure?

What happens after my operation?

What happens when I go home?

 

When do I come into hospital?

I usually perform EVAR procedures on my Friday operating list. I there are no pending investigations to be made and you are a ‘low risk’ patient, you will be admitted to Ward 9 at Manchester Royal Infirmary on Thursday. All other patients are admitted on Wednesday.

 

What happens when I am admitted?

On your admission you will be seen by one of my junior doctors who will obtain a detailed medical history and do a full physical examination. Blood tests will be repeated and any pending investigations (for example heart scan) performed. One of the more senior doctors will take you through the consent form which you are required to sign before we can proceed with surgery. The consent form is a document confirming your understanding of the procedure, its benefits and risks. It also gives us permission to perform the surgery. You will need to be fasting from midnight before your procedure.

 

What are the risks involved?

The EVAR procedure is not without risks. Its advantages are that the risks are reduced when compared to open surgery for aneurysm repair, If you are considered ‘fit’ for an open operation to repair the aneurysm the risk of you dying from a straightforward EVAR procedure is 1 to 3% (as compared to 5 to 7% for the open procedure). This risk is slightly higher for more complex EVAR procedures (such as branched or fenestrated cases). If you are having the EVAR procedure because an open operation was not possible due to your other medical problems, then the risk of dying may be as high as 9%. In such cases we do a cardio-pulmonary assessment (CPX) which gives us a mortality figure (percentage risk of dying) for the individual patient. The risks of the procedure are listed below:

 

Complication associated with EVAR:

All cardiac (heart problems) 5 %

Pulmonary (breathing problems) 3 %

Renal failure (kidney problems) 3 %

Access/deployment failure (problems getting the EVAR device up the arteries in the groins or positioning it into place) 0 -5 %

Thrombotic/embolic 2 %

Gastrointestinal (bowel problems) 2 %

Wound healing/infection 3 %

 

Complications from open surgical repair (for comparison):

All cardiac (heart problems) 12 %

Pulmonary (breathing problems) 9 %

Renal failure (kidney problems) 5 %

Cerebrovascular accident (stroke) 2 %

Thrombotic/embolic 2 %

Gastrointestinal (bowel problems) 5 %

Impotence 60 %

Hematoma/bleeding/coagulopathy 6 %

Wound healing/infection 3 %

 

What happens on the day of the procedure?

You will be taken to the theatre complex in your bed. In the anesthetic room, the anesthetist will give you an epidural unless contraindicated (or you have any objection). This is similar to what is given to women in labor and involves a needle puncture into your back. A very small tube is inserted through this. This tube allows the anesthetist to give you medication that will make you numb from the waist down. Otherwise you will have a general anaesthetic, where you will be asleep for the entire procedure. You will also have a tube in your bladder, so that we can monitor the function of your kidneys; a tube in your hand, so that we can monitor your blood pressure; and you may have a tube in your neck, so that we can monitor how much fluid you have on board (not all patients will need this). If you are having the procedure under epidural, you may want to listen to music during the operation. You can either bring in your own music, or else we can provide you with ours.

 

What happens after my operation?

On completion of the operation you will be transferred to the recovery area in the theatre complex, where you will be taken care of by one of the recovery nurses pending transfer to the High Dependency Unit or the Vascular Ward. All the above mentioned tubes will stay in till the next morning, when all the tubes are removed and you will be encouraged to start walking and moving around. We give all patients aspirin and cholesterol-lowering medication. You are strongly advised to stay on these for life to reduce the risk of developing heart problems or having a stroke as you grow older. During your hospital stay, you will get a mini-injection of heparin (Fragmin). This will thin your blood and prevent you from getting clots whilst you are in hospital. You only need this in hospital to counteract the effect of spending more time immobile in bed or on a chair than you would at home.You may eat and drink as soon as you get back to the ward or high dependency unit. If you have been transferred to the high dependency unit, you will go back to the Vascular Ward the next day assuming that all your observations have been fine. If all is well you should be able to go home on Monday.

 

What happens when I go home?

We will see you again in our outpatient clinic in roughly six weeks Your stitches are what we call dissolvable. This means that they will disappear with time and you do not need to have any stitches removed. Since this is a relatively new procedure and the long-term outcome (beyond 10 years is not yet known) you require long-term follow-up with ultrasound or CT-scan. Our vascular nurse specialist will sort out these appointments for you and once I review the results I will send you a letter explaining the result. Unless there are any problems (and this is exceedingly rare) you do not need to see us in clinic again after your first follow-up appointment.