Abdominal & Thoracic Aortic Aneurysm Treatment: Open Surgery | Q&A


[MUSIC] My name is James Black. I’m a vascular surgeon here at Johns
Hopkins Hospital in Baltimore. I deal with diseases of the arteries and
veins outside of the heart. Open repair of abdominal aortic aneurysms is performed usually through two
approaches. Sometimes we perform an incision right
through the center of the abdomen, that brings us right down to
the aneurysm itself. And the aorta is then opened and replaced
with a graft. Those grafts, we’ve been placing in
patients since the 1950’s. And are quite durable and will last the
patient their entire lifetime. The repair of a thoracic aortic aneurysm using open techniques, usually implies
that the patient has to lie on the right side, and then the
incision comes down between the ribs. And and thereafter, we flex the chest open
and we get to the thoracic aorta in that
location. Similar to the abdominal aortic aneurysm
repair, we also replace the aorta in the chest with a Dacron graft, which can last a patient a lifetime with little fear of degeneration
down the road. Routine abdominal aortic aneurysm repair,
when we, when we do an open, traditional surgical
procedure. Usually requires that the patient come
into the operating room on the day of surgery. And then they’re in the hospital usually
between five and seven days. We, usually one or two of those nights includes a stay in the intensive care
unit, mostly so we can monitor the patient to make sure that they’re coming out of
anaesthesia safely. Then thereafter, we get them out to the
regular hospital floor, start working on moving a diet for getting
people up and around. And on average, most of our patients with
a simple straightforward abdominal aortic aneurysm repair, are going home between
five and seven days after the procedure. For a thoracic aortic aneurysm repair,
when we do an open repair, the are, the stay is
usually longer. Mostly because incision through the chest
wall, is by it’s nature more painful than that of the
abdomen. So we tend to the patients in the hospital
a little bit longer while we wait to take them off appropriate intravenous medications to help control
their pain. Move them towards oral pain medications
and then go home. Follow up after open aortic procedures is dramatically different than that of an
endovascular repair. For an endovascular repair, we almost
always have to have the patient coming back in the first
year. A month after surgery, potentially it’s
six months, then 12 months after the
procedure. For an open repair, we generally have the
patients come back between six and eight, six and eight
weeks after surgery. At that point, we’re mostly beginning to
discuss getting back to activity in terms of limiting, the weight restrictions that
they have upon lifting items, getting back to
exercise. We talk about driving. And generally, most of the patients after
an open aortic repair, are back in the workforce between two and
three months after surgery. Open treatment of aneurysms by its nature
is a more, risky procedure than that of an
endovascular repair. This has been born out in many studies
throughout the last five to ten years. The things we worry about after an open
aneurysm repair, are mostly related to dysfunction of the
kidneys or trouble with the lungs. Of course people who go into the operation
is active smokers or at higher risk for lung
problems than those who are not smokers and
unfortunately, smoking is one of the conditions that leaves people
to have aneurysms. So we have a base problem as the cause of
the aneurysm as well as the cause of most of
the post-operative complications. We have an excellent ICU team here and our
nurses are quite strong in terms of managing the pulmonary aspect
and the lung aspect of the operation. And luckily, we have had a relatively low
rate of pulmonary complications, as well as renal complications or kidney
complications, after any open repair. The best part about working at Hopkins, is working around people who are truly
excellent. There is a very high caliber of physicians
that we have here at Hopkins. Everybody works as a team. There is no one-upping each other to get
ahead. The patient is at the center of the game, and everyone works to get that patient in
better shape. I enjoy coming to work because what I do
is by it’s nature inherently difficult and somewhat
complex, but I like making it look routine. The best reason the patient should
consider coming to Hopkins is because we really put
the patient at the center of the equation. We know based upon our, our own research
here at Hopkins what the best treatments are for a patient in
their given medical fitness. There are many physicians here at Hopkins
who have expertise in many things. There are many people here who are very
good at what they do and we can really bring it all together to
deliver the best outcome for the patient. [MUSIC]


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