Open surgery aortic aneurysm

Open surgery is the standard type of surgery carried out to repair an aneurysm in the aorta (the largest blood vessel in your body) to stop it from bursting. An aneurysm is a widening or bulging of the aorta.

You will meet the surgeon carrying out your procedure to discuss your care. It may differ from what is described here, as it will be designed to meet your individual needs.

How open abdominal aortic aneurysm surgery is carried out
About aortic aneurysms
Diagnosis of aortic aneurysms
What are the alternatives to open surgery?
Preparing for your operation
About the operation
What to expect afterwards
Recovering from open surgery
What are the risks?

How open abdominal aortic aneurysm surgery is carried out

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 About aortic aneurysms

The aorta is usually 2 to 3cm (about one inch) in diameter. A weak spot in the aorta can cause it to bulge outwards (this is called an aneurysm). If the bulge occurs in the aorta as it goes through your chest, it’s called a thoracic aortic aneurysm. If it occurs in the aorta as it goes through your abdomen, it’s called an abdominal aortic aneurysm (AAA). AAAs are more common than thoracic aneurysms.

The chance of an aneurysm rupturing depends on its size. If your aneurysm is greater than 5.5cm wide, the chances of rupture are high – and the risk increases with increasing size. If an aneurysm bursts (ruptures), it can be fatal.

Diagnosis of aortic aneurysms

Aortic aneurysms often don’t have any symptoms, unless they are large or are growing quickly. Your GP may only suspect you have an aortic aneurysm following a routine examination.

If you’re a man over 65, you may be invited to be screened for an abdominal aortic aneurysm at your GP surgery or local hospital. The screening programme only covers abdominal aortic aneurysms, not thoracic aortic aneurysms.

Your doctor will recommend surgery if your aneurysm is more than 5.5cm in diameter or causing symptoms.

What are the alternatives to open surgery?

Your surgeon may suggest doing the procedure using keyhole surgery (see About the operation). Alternatively, your surgeon may suggest another surgical method called endovascular aneurysm repair (EVAR). Endovascular repair isn’t suitable for everyone. It depends on several factors, including the shape of your aneurysm, how near it is to other blood vessels and whether the arteries in your groin are large enough for the stent graft and the delivery device to be inserted.

Your surgeon will advise you which procedure is best for you.

Preparing for your operation

Your surgeon will explain how to prepare for your operation. For example, if you smoke you will be asked to stop, as smoking increases your risk of getting a chest and wound infection, which can slow your recovery.

The operation will be done under general anaesthesia. This means you will be asleep during the operation. You will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it’s important to follow your anaesthetist’s advice.

Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs.

About the operation

Open surgery
Your surgeon will make a cut in your chest or your abdomen, depending on where your aneurysm is. He or she will then open the aorta close to the aneurysm and insert a graft. The graft can be either a piece of blood vessel taken from another place in your body or it can be synthetic. A synthetic graft is made out of an elastic material and is resembles your normal healthy aorta.

The graft will fit into the portion of the aorta that is damaged. Your blood will then flow through the graft, which means there is less pressure on the damaged wall of the aorta.

The cut will be closed with either dissolvable stitches or clips.

Keyhole surgery

The operation can also be performed by keyhole surgery. Two or three small cuts will be made in your abdomen. Your surgeon will insert a tube-like telescopic camera, which will send pictures to a monitor so your surgeon can see the aneurysm. The surgeon will repair the aneurysm using specially designed surgical instruments that will be passed through the other cuts. This surgery isn’t suitable for everybody – ask your surgeon for advice.

What to expect afterwards

After your operation, you may be taken to an intensive care unit (ICU) or a high dependency unit (HDU), where you will be closely monitored for around 24 hours. You may have a tube in your mouth, which passes into your windpipe (trachea) and is connected to a ventilator (a machine to help you breathe). This will be removed once you’re alert and can breathe by yourself.

You will be given painkillers to help with any discomfort as the anaesthetic wears off.

You may have a catheter to drain urine from your bladder into a bag. You may also have fine tubes running out from your wound. These drain fluid into another bag and are usually removed after a day or two.

Once your condition is stable, you will be sent back to a standard ward, where nurses will continue to monitor you until you’re ready to return home. This is usually after about a week.

The length of time your stitches will take to disappear depends on the type you have. They usually disappear in about four to six weeks.

When you’re ready to go home, you will need to arrange for someone to drive you. Try to have a friend or relative stay with you for the first 24 hours. Your nurse will give you some advice about caring for your healing wound before you go home. You may be given a date for a follow-up appointment.

Recovering from open surgery

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

You will probably feel tired for several weeks after the operation, but this will gradually improve.

It usually takes a few months to make a full recovery from this operation. But this can vary between individuals, so it’s important to follow your surgeon’s advice.

What are the risks?

Open surgery for aortic aneurysms is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications.

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure.
After open surgery for aortic aneurysms, your healing wound will feel sore and it may leak fluid. This usually clears after a few days.

Complications

Complications are when problems occur during or after the operation.

The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).

Other complications of open surgery for aortic aneurysm are uncommon but can include:

•    wound infection – you may need treatment with antibiotics if your wound becomes infected
•    impotence (loss of sexual activity) – this can affect some men if nerves in the abdomen are damaged during the operation
•    spinal cord injury – this can leave you paralysed
•    infection of the graft – this is very rare, but serious, and usually means that your graft will have to be removed

The exact risks are specific to you and differ for every person, so we haven't included statistics here. Ask your surgeon to explain how these risks apply to you.