Abdominal aortic aneurysm

Abdominal aortic aneurysm Information for patients from the Vascular Surgery Service This leaflet tells you about a condition known as an abdominal ao...
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Abdominal aortic aneurysm Information for patients from the Vascular Surgery Service This leaflet tells you about a condition known as an abdominal aortic aneurysm; it explains what the condition is, how it is monitored and briefly describes the surgical treatment options. There are separate more detailed leaflets about the two surgical options available. This leaflet is not meant to replace the information discussed between you and your doctor but can act as a starting point for such a discussion or as a useful reminder of the key points. What is an aneurysm? An aneurysm is the stretching of a weakened artery which balloons out rather like a worn-out tyre. The wall of the artery becomes thinned by loss of elastic tissue and the artery expands making it likely to burst. The most common artery to be affected is the aorta which is the main artery in the tummy (abdomen). In England and Wales, between 6,000 and 10,000 people per year suffer from rupture of an abdominal aortic aneurysm which is usually fatal. Most of these patients are men over the age of 60 years. Smoking and high blood pressure are known to increase the risk of developing an aneurysm.

Aorta

Iliac artery

How is an abdominal aortic aneurysm detected? Some patients have the aneurysm detected coincidentally when they are examined for another problem or if they have a scan for another reason, such as kidney trouble or gallstones. Occasionally, a patient may become aware of a feeling of pulsation in the abdomen. As an aortic aneurysm stretches, it can cause pain in the back or abdomen but pain is not at all common. If an aneurysm is suspected, your GP may refer you to a specialist vascular surgeon for advice; your GP or vascular surgeon will order an ultrasound scan. Ultrasound screening of the abdomen is a painless outpatient test that will only take a few minutes to do. It is used to decide whether an aneurysm is present and to measure its approximate size and position. Who is at risk? It is known that men over the age of 60, younger men with a brother or father who have had an aneurysm, or men with other arterial disease (angina or heart attack), hardening of the arteries (atherosclerosis), or high blood pressure are at increased risk. The commonest type of aneurysm is due to smoking. As part of a national screening program, men aged 65 years and also people who are known to be at increased risk of having an abdominal aortic aneurysm are being offered screening by ultrasound scan. This service is offered through the vascular assessment unit at Kent and Canterbury Hospital. Do I need surgery? Not all aneurysms need an operation. The risk of rupture and therefore the need for repair depends on the size of the aneurysm. If the aneurysm is large (more than 5.5 centimetres (cm) in diameter), it is often safer to repair than to leave it alone. This protects the aorta from rupture. Smaller aneurysms are usually observed by repeating scanning at six to 12 monthly intervals in case they enlarge and thus become dangerous. The average enlargement is about 0.3cm per year so surgery can be required at a later date if yours grows, though not all do. What types of surgery are there and what do they involve? Surgical treatment involves the insertion of a new tube lining into the swollen part of the aorta (like an inner tube of a tyre). This tube is made of strong material such as Dacron or Teflon which can last for 20 years or more. This tube can be inserted via an incision on your abdomen (open repair) or via incisions in each groin (stent grafting or EVAR (Endovascular)). EVAR is not suitable for all patients but when feasible can reduce the risk of some of the potential complications of open repair. These methods will be considered in detail for you by your vascular team.

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Abdominal aortic aneurysm, June 2015 (version 2)

Is surgery successful? If aneurysms are repaired before rupture, there is a high overall chance of successful repair and a return to normal life and life-expectancy. However, you should discuss the risks of surgery in your particular case with your doctors. The risks attached to the open repair through an incision in your abdomen are of you having medical complications such as heart attack, stroke, kidney failure, chest problems, loss of circulation to the legs, kidneys or bowel, deep vein thrombosis (blood clot in leg vein), and infection of the artificial artery. Each of these is rare, but it does mean overall that some patients may have a fatal complication from their operation. For most the risk is about 2% - in other words 98 in every 100 patients will make it through the operation. With EVAR, the serious complications in open repair are reduced in frequency as indicated above but the main complications are leaking groin wounds which may become infected, a risk of the graft moving or losing its seal resulting in a leakage of blood into the aneurysm, and of blockage of the stent graft by a kink or blood clot. If this happens, you may require an operation to restore the blood supply to the leg(s). There is an increased chance of patients needing further treatment to deal with these complications compared to open repair but the lower risk of not surviving the operation is only around 1%. The different types of complications related to the two types of aneurysm repair operations are explained in more detail in separate leaflets which are available for your information. Additional advice for patients who have an aneurysm Drivers Group One Entitlement ODL – Car, Motorcycle - The DVLA (Driver and Vehicle Licensing Agency) should be notified of any aneurysm that reaches 6cm (centimetres) or greater in diameter. Licensing will be permitted subject to annual review. Driving may be continued after a satisfactory medical (blood pressure control) or surgical treatment, with no evidence of further enlargement of the aneurysm unless other disqualifying condition. An aortic diameter of 6.5cm or greater disqualifies you from driving. Group Two Entitlement VOC – LGV/PCV – Disqualifies you from driving if the aorta diameter is greater than 5.5cm. Driving may continue after satisfactory medical or surgical treatment, unless there is another disqualifying condition. Reference www.dvla.gov.uk/at-a-glance/ch2-cardiovascular Flying If you have an aneurysm and are considering a holiday which involves flying, you will need to declare this condition to your travel insurance company. This is because some insurance companies will not provide cover for you because some airlines refuse patients with this condition as there is an increased risk of rupture at altitude. When booking a flight or holiday, it is advisable to check with the airline at the same time. Some insurance companies will provide cover as long as you have the permission of your consultant to fly. If you have any concerns about this please contact us on the telephone numbers on page 4.

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Abdominal aortic aneurysm, June 2015 (version 2)

Activity Often the first description of an aneurysm can be frightening and many patients have concerns about returning to normal life for fear of causing the aneurysm to rupture. We encourage you to resume the usual activities that you undertook before you knew that you had this condition. If we have any concerns then these will be discussed with you. You should use this opportunity to optimise your health by stopping smoking and getting fitter in case you ever need surgery to repair your aneurysm and reduce the risk of complications occurring. Finally…. Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion about your treatment with the doctors looking after you. Make sure you are satisfied that you have received enough information about this condition. Source of information The information within this leaflet is based on current practice undertaken by your consultant and from national guidelines. If you have any comments regarding this leaflet, we would appreciate your feedback. Where can I get more information? If you have any questions or concerns, please contact one of the following: during the working day, first try the vascular nurse or, if unable to get through or out of hours ask the hospital switchboard for the vascular registrar on call. • Vascular Nurse Practitioners

Telephone: 01227 864137 Email: [email protected]

• Kent and Canterbury Hospital (K&C)

Telephone: 01227 766877 (out of hours for Registrar on call)

or your consultant’s secretary • Mr Insall, Kent and Canterbury Hospital Telephone: 01227 864259 • Mr Rix and Mr Senaratne, Kent and Canterbury Hospital Telephone: 01227 783196 • Mr Wilson, Kent and Canterbury Hospital Telephone: 01227 864255 Useful web addresses • National Institute for Health and Care Excellence www.nice.org.uk • Vascular Society of Great Britain and Ireland www.vascularsociety.org.uk • Circulation Foundation www.circulationfoundation.org.uk

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Abdominal aortic aneurysm, June 2015 (version 2)

Any complaints, comments, concerns, or compliments If you have other concerns please talk to your doctor or nurse. Alternatively please contact our Patient Advice and Liaison Service (PALS) on 01227 783145 or 01227 864314, or email [email protected] Further patient information leaflets In addition to this leaflet, East Kent Hospitals has a wide range of other patient information leaflets covering conditions, services, and clinical procedures carried out by the Trust. For a full listing please go to www.ekhuft.nhs.uk/patientinformation or contact a member of staff. After reading this information, do you have any further questions or comments? If so, please list below and bring to the attention of your nurse or consultant.

Would you like the information in this leaflet in another format or language?

We value equality of access to our information and services and are therefore happy to provide the information in this leaflet in Braille, large print, or audio - upon request. If you would like a copy of this document in your language, please contact the ward or department responsible for your care. Pacjenci chcący uzyskać kopię tego dokumentu w swoim języku ojczystym powinni skontaktować się z oddziałem lub działem odpowiedzialnym za opiekę nad nimi. Ak by ste chceli kópiu tohto dokumentu vo vašom jazyku, prosím skontaktujte nemocničné pracovisko, alebo oddelenie zodpovedné za starostlivosť o vás. Pokud byste měli zájem o kopii tohoto dokumentu ve svém jazyce, kontaktujte prosím oddělení odpovídající za Vaši péči. Чтобы получить копию этого документа на вашем родном языке, пожалуйста обратитесь в отделение, ответственное за ваше лечение. We have allocated parking spaces for disabled people, automatic doors, induction loops, and can provide interpretation. For assistance, please contact a member of staff. This leaflet has been produced with and for patients Information produced by the Vascular Team, East Kent Vascular Unit, Kent and Canterbury Hospital, Canterbury Date reviewed: June 2015 (version 2) Next review date: June 2017 Web 024