Abdominal aortic aneurysm repair - open
AAA - open; Repair - aortic aneurysm - open
Open abdominal aortic aneurysm (AAA) repair is surgery to fix a widened part in your aorta. This is called an aneurysm. The aorta is the large artery that carries blood to your belly (abdomen), pelvis, and legs.
An aortic aneurysm is when part of this artery becomes too large or balloons outward.
Your blood vessels are the transport system that carries blood to and from your heart, to the rest of your body. Usually, everything runs pretty smoothly with this system, but sometimes there can be a problem. For example, one of the large blood vessels that supplies blood to your abdomen and lower body can swell up or bulge. This bulge is called an abdominal aortic aneurysm, and it can be pretty serious if it breaks open, or ruptures. Let's talk about abdominal aortic aneurysm. This is the descending aorta, one of the large blood vessels that sends blood to your abdomen and legs. Over a period of many years, this blood vessel can start to bulge. Although doctors aren't sure exactly what causes an aneurysm, they do know that it's more common in males over 60 and people who are overweight, who smoke, or who have high blood pressure or cholesterol. Eventually, if not treated, the aneurysm can pop open or rupture, and spill blood into your abdominal cavity or into the wall of the artery. If an aneurysm ruptures, it is considered a true medical emergency. So, how do you find out if you have an aneurysm? You may not realize that you have one, because often aneurysms don't cause any symptoms until they rupture. An imaging test like a CT scan or ultrasound may help in finding a suspected aneurysm. If it does break open, you may feel severe pain in your stomach. That pain may spread to your groin, buttocks, or legs. You could also feel sick to your stomach, have clammy skin, and your heart may beat faster than normal. If you have any of these symptoms, see your doctor, who can examine you. Your doctor may also recommend an imaging test to see for sure if you have an aneurysm. Treatments for aneurysms vary depending on how severe the aneurysm is. If you're not having symptoms, and your aneurysm is small and hasn't broken open, your doctor may suggest just checking it every six months to make sure it doesn't get bigger. If it's bigger than 2 inches, you'll probably need to have surgery. The goal is to perform surgery before complications and symptoms develop. The surgeon will replace the damaged, bulging section of blood vessel with a section of man-made vessel, commonly called a graft. It's better to avoid getting an aneurysm than to have to treat it. Eat a healthy diet, watch your cholesterol and blood pressure levels, and quit smoking to help prevent an aneurysm from forming in the first place. Men who are over the age of 65 and have ever smoked or who have a close relative who's had an abdominal aortic aneurysm should have one screening ultrasound done to check for an abdominal aortic aneurysm. If you're having any symptoms of an abdominal aneurysm, like severe pain in your belly or back, it's very important that you get medical help right away. Go to the emergency room or call your health care provider for immediate help. Small aneurysms are easy to treat with surgery. But once they get larger and rupture, they can be life threatening.
The surgery will take place in an operating room. You will be given general anesthesia (you will be asleep and pain-free).
Your surgeon opens up your belly and replaces the aortic aneurysm with a man-made, cloth-like material.
Here is how it can be done:
- In one approach, you will lie on your back. The surgeon will make a cut in the middle of your belly, from just below the breastbone to below the belly button. Rarely, the cut goes across the belly.
- In another approach, you will lie slightly tilted on your right side. The surgeon will make a 5- to 6-inch (13 to 15 centimeters) cut from the left side of your belly, ending a little below your belly button.
- Your surgeon will replace the aneurysm with a long tube made of man-made (synthetic) cloth. It is sewn in with stitches.
- In some cases, the ends of this tube (or graft) will be moved through blood vessels in each groin and attached to those in the leg.
- Once the surgery is done, your legs will be examined to make sure that there is a pulse. Most often a dye test using x-rays is done to confirm that there is good blood flow to the legs.
- The cut is closed with sutures or staples.
Surgery for aortic aneurysm replacement may take 2 to 4 hours. Most people recover in the intensive care unit (ICU) after the surgery.
Why the Procedure Is Performed
Open surgery to repair an AAA is sometimes done as an emergency procedure when there is bleeding inside your body from the aneurysm.
You may have an AAA that is not causing any symptoms or problems. Your health care provider may have found the problem after you had an ultrasound or CT scan done for another reason. There is a risk that this aneurysm may suddenly break open (rupture) if you do not have surgery to repair it. However, surgery to repair the aneurysm may also be risky, depending on your overall health.
You and your provider must decide whether the risk of having this surgery is smaller than the risk for rupture. Surgery is more likely to be suggested if the aneurysm is:
- Larger (about 2 inches or 5 centimeters)
- Growing more quickly (a little less than 1/4 inch over the last 6 to 12 months)
The risks for this surgery are higher if you have:
Complications are also higher for older people.
Risks for any surgery are:
- Blood clots in the legs that may travel to the lungs
- Breathing problems
- Heart attack or stroke
- Infection, including in the lungs (pneumonia), urinary tract, and belly
- Reactions to medicines
Risks for this surgery are:
- Bleeding before or after surgery
- Damage to a nerve, causing pain or numbness in the leg
- Damage to your intestines or other nearby organs
- Loss of blood supply to a portion of the large intestine causing delayed bleeding in the stool
- Infection of the graft
- Injury to the ureter, the tube that carries urine from your kidneys to your bladder
- Kidney failure that may be permanent
- Lower sex drive or inability to get an erection
- Poor blood supply to your legs, your kidneys, or other organs
- Spinal cord injury
- Wound breaks open
- Wound infections
Before the Procedure
Your will have a physical exam and get tests before you have surgery.
Always tell your provider what medicines you are taking, even drugs, supplements, or herbs you bought without a prescription.
If you are a smoker, you should stop smoking at least 4 weeks before your surgery. Your provider can help.
During the 2 weeks before your surgery:
- You may be asked to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), clopidogrel (Plavix), naprosyn (Aleve, Naproxen), and other drugs like these.
- Ask which drugs you should still take on the day of your surgery.
- Always tell your provider if you have a cold, flu, fever, herpes breakout, or other illness before your surgery.
DO NOT drink anything after midnight the day before your surgery, including water.
On the day of your surgery:
- Take the drugs you were told to take with a small sip of water.
- You will be told when to arrive at the hospital.
After the Procedure
Most people stay in the hospital for 5 to 10 days. During a hospital stay, you will:
- Be in the intensive care unit (ICU), where you will be monitored very closely right after surgery. You may need a breathing machine during the first day.
- Have a urinary catheter.
- Have a tube that goes through your nose into your stomach to help drain fluids for 1 or 2 days. You will then slowly begin drinking, then eating.
- Receive medicine to keep your blood thin.
- Be encouraged to sit on the side of the bed and then walk.
- Wear special stockings to prevent blood clots in your legs.
- Be asked to use a breathing machine to help clear your lungs.
- Receive pain medicine into your veins or into the space that surrounds your spinal cord (epidural).
Full recovery for open surgery to repair an aortic aneurysm may take 2 or 3 months. Most people make a full recovery from this surgery.
Most people who have an aneurysm repaired before it breaks open (ruptures) have a good outlook.
Ramdon AR, Roddy SP, Darling C. Management of ruptured abdominal aortic aneurysms. In: Cameron AM, Cameron JL, eds. Current Surgical Therapy. 13th ed. Philadelphia, PA: Elsevier; 2020: 911-915.
Woo EY, Damrauer SM. Abdominal aortic aneurysms: open surgical treatment. In: Sidawy AN, Perler BA, eds. Rutherford's Vascular Surgery and Endovascular Therapy. 9th ed. Philadelphia, PA: Elsevier; 2019:chap 71.
Last reviewed on: 10/30/2020
Reviewed by: Deepak Sudheendra, MD, RPVI, FSIR, Director of DVT & Complex Venous Disease Program, Assistant Professor of Interventional Radiology & Surgery at the University of Pennsylvania Perelman School of Medicine, with an expertise in Vascular Interventional Radiology & Surgical Critical Care, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.