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Abdominal aortic aneurysm repair - open
Definition
Open abdominal aortic aneurysm repair is surgery to fix a widened part (aneurysm) in your aorta, 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 surgeon opens up your belly and replaces the aortic aneurysm with a man-made, cloth-like material.
Alternative Names
AAA - open; Repair - aortic aneurysm - open
Description
The surgery will take place in an operating room. You will be given general anesthesia (you will be asleep and pain-free).
- 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 navel. 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 cut from the left side of your belly, ending a little below your belly button.
- Your surgeon will then replace the part of the aorta that has the aneurysm with a long tube graft. This tube graft is made from man-made (synthetic) cloth and is sewn in with sutures.
- In some cases, the ends of the tube graft will be tunneled through each groin and attached to the leg vessels.
- Once the surgery is done, your legs will be examined to make sure that there is a pulse.
- The cut is closed with sutures or staples.
Surgery for aortic aneurysm replacement may take 2 to 4 hours. Most patients recover in the intensive care unit (ICU) after the surgery.
See also: Aortic aneurysm repair - endovascular
Why the Procedure Is Performed
Open surgery to repair an abdominal aortic aneurysm is sometimes done as an emergency procedure when there is any bleeding inside your body from the aneurysm.
You may also have an abdominal aortic aneurysm that is not causing any symptoms or problems. Your doctor may have found out about this problem from tests called ultrasound or CT scan. 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 doctor must decide whether the risk of having this surgery is smaller than the risk of rupture if you do not have the surgery. The doctor is more likely to recommend surgery if the aneurysm is:
- Larger (about 2 inches or 5 cm)
- Growing more quickly (a little less than 1/4 inch over the last 6 to 12 months)
Risks
The risks for this surgery are higher if you have:
- Heart disease
- Kidney failure
- Lung disease
- Past stroke
- Other serious medical problems
Risks of problems or 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
- Infection of the graft
- Injury to the ureter, the tube that carries urine from your kidneys to your bladder
- 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 doctor will do a thorough physical exam and tests before you have surgery.
Always tell your doctor or nurse what drugs 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 doctor or nurse can help.
During the 2 weeks before your surgery:
- You will have visits with your doctor to make sure medical problems such as diabetes, high blood pressure, and heart or lung problems are being treated well.
- 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 your doctor which drugs you should still take on the day of your surgery.
- Always let your doctor know about any cold, flu, fever, herpes breakout, or other illness you may have 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 your doctor told you to take with a small sip of water.
- Your doctor or nurse will tell you 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)
Outlook (Prognosis)
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.
References
Gloviczki P, Ricotta JJ II. Aneurysmal vascular disease. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 65.
De Bruin JL, Baas AF, Buth J, Brinssen M, Verhoeven EL, Cuypers PW, et al: DREAM Study Group. Long-term outcome of open or endovascular repair of abdominal aortic aneurysm. N Engl J Med; 2010:362:1881-1889.
United Kingdom EVAR Trial Investigators, Grenhalgh RM, Brown LC, Powell JT, Thompson SG, Epstein D, Sculpher MJ. Endovascular versus open repair of abdominal aortic aneurysm. N Engl J Med; 2010;362:1863-1871.
Reviewed By: Shabir Bhimji, MD, PhD, Specializing in General Surgery, Cardiothoracic and Vascular Surgery, Midland, TX. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
