Open Subclavian Aneurysm Repair
The subclavian artery carries blood from the heart to the arms. An aneurysm is a balloon-like bulge in the wall of an artery. It can form when a portion of the wall of the subclavian artery thins and weakens. Over time, the aneurysm can grow so large that it bursts (ruptures). This can cause severe pain and bleeding. Even if the aneurysm doesn’t burst, blood can become trapped inside it and form a clot. The clot can block blood flow to the arm, causing symptoms such as arm or hand pain. If parts of the clot break off and travel to the brain, they can cause a stroke. Repair of the aneurysm is needed to prevent these problems from occurring. This can be done using open surgery. With this method, the aneurysm is repaired through one or more incisions. This sheet tells you more about what to expect.
Preparing for Surgery
Prepare as you have been told. Tell your doctor about all medications you take. This includes over-the-counter drugs. It also includes herbs and other supplements. You may need to stop taking some or all of them before the surgery. Also, follow any directions you’re given for not eating or drinking before surgery.
The Day of Surgery
The surgery takes about
Before the surgery begins:
An IV line is put into a vein in your arm or hand. This line supplies fluids and medications.
To keep you free of pain during the surgery, you’re given general anesthesia. This medication puts you in a state like deep sleep through the surgery.
A thin tube (catheter) may be placed into your bladder to drain urine. It may be used through the surgery and for a time afterward.
During the surgery:
One or more incisions will be made to repair the aneurysm. Possible incision sites include the neck, chest, and arm.
Nearby muscle or bone (such as a rib) may be removed if it is pressing on the artery and causing symptoms.
Blood thinners are given through the IV line to help prevent blood clots.
The artery is clamped above and below the aneurysm to stop blood flow.
The aneurysm is opened and cleaned of any blood clots.
A graft (substitute blood vessel) is then used to help with the repair. The graft may be a tube made from special fabric. Or, it may be tissue taken from your own body. If your own tissue is used, it is usually taken from a vein in your leg.
The graft is sewn to healthy portions of the artery at either end of the aneurysm. The wall of the aneurysm is then sewn over the graft. (In some cases, the portion of the artery that contains the aneurysm is removed.)
Or, the aneurysm is tied off at either end. The graft is then sewn into place above and below the aneurysm. This is called a bypass. It reroutes blood flow around the part of the artery that contains the aneurysm.
When the repair is complete, the clamps are removed to restore blood flow through the artery.
The skin incisions are closed with stitches (sutures) or staples. Small tubes (drains) may be placed near any incisions. These drains remove fluid that can build up after the surgery.
Recovering in the Hospital
After the surgery, you may need to stay in the hospital for
You may have imaging tests to make sure the graft is working properly.
The tube to drain urine will be removed.
You’ll be given medications to manage any pain. Let your providers know if your pain is not controlled.
You’ll be taught coughing and breathing techniques to keep your lungs clear.
When you’re able, you’ll need to stand and walk for brief periods. A nurse or therapist will help you.
When it’s time for you to go home, have an adult family member or friend ready to drive you. Also, arrange for someone to help you at home for the first couple of days.
Recovering at Home
Once at home, follow any instructions you’ve been given. Be sure to:
Take all medications as directed.
Care for your incisions as instructed.
Check for signs of infection at any incision sites (see below).
Avoid heavy lifting and strenuous activities as directed.
Walk at least a few times daily. Slowly increase your pace and distance as you feel able.
Avoid driving until your doctor says it’s okay. Do not drive while taking medications that can make you drowsy or sleepy.
Call the Doctor If You Have Any of the Following:
New or increased pain in your chest or trouble breathing
100.4° F( 38° C) or higher, or as directed by your healthcare provider
Return of previous symptoms
Signs of infection at any incision sites, such as increased redness, swelling, warmth, worsening pain, bleeding, or foul-smelling drainage
Pain that worsens or that cannot be controlled with medications
Pain, numbness, or tingling in the arm, hand, or fingers
Rapid, pounding, or irregular heartbeat
Pain or swelling in the legs
You will have a follow-up visit with your doctor within 2 to 3 weeks. This lets your doctor check how well you’re healing and remove any stitches or staples, if needed.
Risks and Possible Complications Include:
Problems with the graft, such as movement of the graft from its original location or blood clots at the graft
Injury to nearby blood vessels, muscles, bones, and organs
Injury to the nerve that leads to your diaphragm, which may cause problems with breathing
Injury to specific nerves that affect the eyes and face, causing Horner’s syndrome (signs of this condition include partial drooping of the eyelid and a constricted pupil)
Abnormal buildup of fluid around the lungs
Risks of anesthesia