Do you need to have an operation due to an aneurysm? (Aneurysm Surgery) Let's talk about this simply.

It's normal to feel a little scared and nervous when the doctor tells you or someone in your family has an "aneurysm" and that you need to have an operation for it. When you hear this word, a lot of things come to mind. So today, let's learn more about this, that is, this aneurysm surgery. I will explain everything to you simply and clearly, just like you would talk to a friend.

What exactly is aneurysm surgery?

Simply put, aneurysm surgery is a treatment for a weakening in the aorta, the main blood vessel in our body. Imagine a water pipe that weakens at one point and bulges like a balloon. In the same way, when the aorta weakens at one point and bulges, we call it an aortic aneurysm. This is dangerous because this bulge can burst (rupture) or tear (dissection) at any time. If that happens, it can be very dangerous even for life.

So the main goal of this operation is to remove the swollen, weakened blood vessel before it bursts and replace it with a strong synthetic fabric tube. We call this a graft . This graft works like a brand new blood vessel. Then the blood flows through it without any risk.

This is considered major surgery. It is usually performed by a thoracic or vascular surgeon in a hospital operating room. Depending on the location of the aneurysm, the doctor may need to make a large incision in the chest or abdomen.

• We call an aneurysm in the chest area a Thoracic Aortic Aneurysm .
• A little lower, that is, in the abdominal area, is called an Abdominal Aortic Aneurysm .

This surgery is essential to avoid major risks. As with all major surgeries, there are some minor risks, but the benefits far outweigh them. Your doctor will carefully examine your condition and decide whether you need surgery or not.

Who really needs this surgery?

This can be divided into two parts. One is an emergency. The other is a situation where you plan ahead before an emergency occurs.

1. People who have had a ruptured or ruptured aneurysm (an emergency)

This is the most dangerous and urgent situation. If an aneurysm bursts or ruptures, immediate surgery is required. This is the only way to save a life. If the symptoms below suddenly appear, you should immediately go to the Emergency Department (ETU) of a hospital .

2. People with an aneurysm that is at risk of bursting

If your doctor has found that you have an aneurysm, even if it hasn't burst, it's important to see your doctor regularly to check its condition. Your doctor will look at its size and how fast it's growing to determine the best time to perform surgery. You may need surgery if you have any of the following conditions:

• If the aneurysm is larger than 5 centimeters in diameter .
• If it is growing rapidly (for example, more than 1 centimeter per year).
• If you experience frequent pain in areas such as the stomach, back, chest, or groin.
• If you feel a pulsing sensation in your stomach.
• If you have a cough, hoarseness, or difficulty breathing.

For example, if you have a genetic condition like Marfan syndrome , even a relatively small aneurysm can be dangerous for you. Therefore, you may be recommended to have surgery earlier than someone else.

Sometimes, due to other health problems, it can be risky to have a major open surgery like this. In such cases, your doctor may recommend a less complicated procedure called EVAR (Endovascular Aneurysm Repair) , where a tube is inserted through a much smaller incision into the blood vessel.

How do you prepare before the operation?

Preparing for a major surgery like this starts a few weeks in advance. Your doctor will examine you thoroughly and run several tests to make sure your body is in the right condition for the surgery. During this time, you should definitely talk to your doctor about the following:

• You should tell your doctor about all the medications you are taking: prescription medications, over-the-counter medications, vitamins, herbal remedies, and everything else you are taking. You may be asked to stop taking certain medications before surgery. It is very important to follow your doctor's instructions exactly as they are given.
• About other medical conditions you have: If you have any medical conditions such as high blood pressure or diabetes, they should be well controlled before surgery.
• About your physical health: Tell your doctor if you have a cold, flu, herpes, or any other illness. It is not a good idea to undergo surgery when you are sick.
• If you smoke: You should stop smoking completely at least one month before surgery. If you need help with this, ask your doctor, he or she will be able to help you.

You will also be given a series of special instructions to prepare for the day of surgery. Some of them include:

• The night before the surgery, you're told not to drink water after midnight.
• What medication should I take the morning of the surgery?
• Asking to arrange for someone to pick you up when you get home from the hospital.

Follow all of these instructions carefully. If there is anything you are not sure about, ask your doctor or nurse.

What really happens inside the operation?

You may be very curious and scared about this. But don't worry. Your medical team will take good care of you. Before the surgery begins, you will be given general anesthesia . Then you will be completely asleep and will not feel anything. Then the surgery will take place according to these steps:

1. Incision: The surgeon makes a long cut in the skin of your chest or abdomen to reach the location of the aneurysm.

2. Clamping: Next, the large artery above and below the aneurysm is temporarily closed using special devices (clamps). At this time, blood flow to the rest of the body is allowed to continue, and you may be connected to a heart-lung machine . This temporarily takes over the work of your heart and lungs during surgery.

3. Graft Insertion: This is the most important part of the surgery. The surgeon cuts out the swollen, weakened blood vessel and replaces it with the previously mentioned artificial tube, the graft. This graft is made of a strong synthetic material such as polyester.

4. Closure of the incision:After the new blood vessel is attached, the surgeon will close the incision in your chest or abdomen with stitches or staples.

Usually, this entire surgery takes about three to four hours.

What happens after the operation?

After the surgery, you will be taken to the intensive care unit (ICU) . There, your condition will be monitored very closely for a few days. Then you will be transferred to a regular ward. In total, you will have to stay in the hospital for about three to ten days.

While in the hospital, you will face things like:

• A urinary catheter.
• A tube inserted through the nose to remove fluid from the stomach.
• Medicines to prevent blood clotting (anti-coagulants).
• Compression socks are a special type of socks worn to prevent blood clots in the legs.
• A machine that helps you breathe.
• Painkillers for pain during recovery.

You will gradually start walking and gain strength. But remember, you have undergone a major surgery. You need to give your body time to heal. Listen carefully to what the doctor says, don't rush it. Get plenty of rest.

Like all surgeries, are there any risks with this?

Yes. Although this surgery is life-saving, as with all surgeries, there are risks and complications that can occur. Some of them are:

• Excessive bleeding.
• Blood clots.
• Difficulty breathing.
• Damage to the intestines or other organs.
• Heart attack or stroke.
• Infection of the inserted graft.
• Lung, urinary tract, or abdominal infections.
• Kidney failure.
• Nerve damage.

If the surgery is planned and performed before an aneurysm ruptures , the chances of survival are very high, between 95% and 98% .

However, in the event of an emergency surgery after an aneurysm ruptures , the chance of survival can drop to between 50% and 70%. But since death is certain if left untreated, surgery is the only and best solution.

Recovery period and things to pay attention to at home

This is an important part for many people.

How long does it take to heal?

It usually takes four to six weeks to fully recover.It takes about 10-20 days. But some people can go for two to three months. It varies from person to person.

Things not to do during this time

• Do not drive until your doctor gives you permission (usually one to two weeks).
• Don't get in a tub of water until the wound is healed. You can take a shower, but be careful of the wound.
• Do not swim until the wound heals.
• Do not lift heavy objects (more than 4-5 kg) for at least 4-6 weeks.
• Don't exercise so hard that you get out of breath.

How to care for the surgical wound?

It is very important to keep your wound clean. As the doctor says, you will need to change the dressing on the wound every day. It may hurt a little when you sneeze or cough. At that time , take a pillow and place it over the wound and press it . That will reduce the pain and protect the wound.

Appetite and energy

During your recovery, you may not have much of an appetite. That's normal. You may also feel very tired. These are all part of the recovery process.

If you have these symptoms, call your doctor immediately!

Be very careful about your body after you get home. If you have any of the symptoms below, inform your doctor immediately.

Lifestyle changes you need to make after surgery

This surgery is a big investment in your health. It's up to you to protect that investment.

• Heart-healthy diet: Reduce salt, sugar, and oil. Drink plenty of water.
• Exercise: Ask your doctor what exercises are right for you.
• If you smoke, stop now: Smoking is very harmful to your blood vessels.
• Control high blood pressure, cholesterol, and diabetes: Take your medications on time.

Aneurysm surgery is a life-saving procedure that helps your blood vessels heal. For some, it is an emergency procedure. For others, it is something that is planned months in advance. However, it is not without risks. So, talk to your doctor about the best treatment for you. Regular checkups are the best way to find an aneurysm before it grows larger and becomes a problem.