Complications of aneurysm repair
Complications of aneurysm surgery can be considered as immediate, early or late:
Immediate
This means problems arising during the operation and can include complications of the anaesthetic:
 | bleeding during the dissection - may be from the aneurysm, the veins or damage to nearby veins and arteries. |
| damage to the ureters - the tubes that lead from the kidneys to the bladder. They run next to the aneurysm. |
| damage to the bowel - this may mean delaying the aneurysm repair to avoid infection of the graft. |
| 'trashing' - this is the dislodgement of atheroma from the aneurysm allowing it to move down the arteries, blocking them. Mostly identified during the operation and removed using special balloons. Sometimes the debris may be very small and blocks small arteries from where it cannot be removed. This will result in the death of some tissues e.g. areas of the buttocks, thighs and feet. |
| heart problems - such as odd rhythms or a heart attack. |
| kidney problems - the kidney stops working because of drops in blood pressure or because the clamp on the aorta has to be placed above the point at which the arteries to the kidneys come off. |
Early
These occur in the few days after the operation:
| bleeding - usually in the first few hours after the operation and needs another operation to correct the problem. |
| death - this occurs in about 8 - 10% of cases. The figure may be higher if the patient has co-existing severe heart, lung or kidney disease. Most of the deaths are due to heart problems. |
| heart problems - affect about 15% of cases. They include odd rhythms or heart attacks. |
| lung problems - usually chest infection. Can affect 8 - 12% to varying degrees. |
| kidney problems - affect 5 - 12% of cases. If the kidneys shut down (usually temporary) the blood may need to be filtered (a form of dialysis) for a while to remove toxic substances and excess fluid. |
| deep vein thrombosis - can be present in 8% of cases. Some may lead to a pulmonary embolus (clot dislodging and moving along the blood stream to the lungs) and possible death. |
| bowel problems - the most serious of these is death of a piece of bowel because of damage to its blood supply. That part of the bowel would need to be removed. Fortunately it is not a very common problem. Blockage of the bowel because of kinks may occur. Constipation is common. |
Late
These occur in the months or years following surgery:
| death - patients who have had an aneurysm repair tend not to live as long as otherwise healthy people. The most common cause of death is heart related. |
| impotence - this is not an uncommon problem and is due to damage to sympathetic nerves that lie on the aortic aneurysm. |
| false aneurysm - there is a 1% chance of this happening at 8 - 10 years after the operation. See 'what is an aneurysm' for an explanation of a false aneurysm. |
| graft infection - this occurs in about 1% of cases. |
| aorto-enteric fistula - this is a communication between the bowel and the area of aneurysm repair. It usually starts after graft infection. The patient presents with blood loss into the gut (vomiting or passing blood from the back passage). It requires emergency treatment and carries a high risk of death. |
| other aneurysms - the rest of the aorta may form an aneurysm or other aneurysms may develop in the arterial tree. |