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Open surgery is done to repair an abdominal
aortic aneurysm. It is called an open surgery because the abdomen is opened so the doctor can see and work on the aorta. Open surgery is the traditional method of repair.
To repair the aneurysm, a doctor uses a man-made tube (called a graft) to replace the weak and bulging section of the aorta in the belly.
General anesthesia is used for this surgery.
The doctor makes a large cut (incision) in the belly or the side of the abdomen. The doctor puts clamps on the aorta above and below the aneurysm. This stops blood flow through the area that the doctor is working on. The doctor removes the aneurysm and attaches the graft to the aorta. For some aneurysms, the
doctor leaves the aneurysm wall intact, and the graft is placed
inside the aneurysm.
After the aorta is repaired, the doctor removes the clamps so that blood can flow through the aorta again. Then the doctor uses stitches or staples to close the incision in the belly.
You will stay in the hospital for a few days to recover.
You can expect the cut (incision) in your belly to be sore for a few weeks. You will feel more tired than usual for several weeks after surgery. You may be able to do many of your usual activities after 4 to 6 weeks. But you will probably need 2 to 3 months to fully recover.
You will have follow-up visits with your doctor to check on your recovery. Then, you will likely have annual checkups. You might have a test, such as a CT scan or ultrasound, every few years to check your repaired aorta.1
Repairing an aortic aneurysm is typically recommended if the aneurysm is at risk of bursting open (rupturing). Aortic aneurysms that
are large, are causing symptoms, or are rapidly getting bigger are considered at risk of rupturing.
In men, repair is typically recommended for
an abdominal aortic aneurysm that is 5.5 cm or larger
in diameter. In women, repair may be recommended for smaller aneurysms.2
Your doctor will work with you to decide which type of repair surgery, open or endovascular, is right for you. Your doctor will check:3
When an aortic aneurysm is at risk of rupturing, or bursting open, the benefits of repairing the aneurysm can outweigh the risks. Repairing the aneurysm lowers the risk of rupture. And the repair can help a person live longer. Repairing a smaller aneurysm, which doesn't have as high a risk of rupture, does not help a person live longer.4
Overall, open repair surgery and endovascular repair have similar outcomes and long-term benefits.3
Most people who have open repair surgery recover
well. But this surgery has serious risks during surgery and soon after surgery.
About 4 to 8 out of 100 people die during surgery or within 30 days.1 Your risk may be lower depending on your health
before surgery and where the aneurysm is located.
Problems during the surgery happen to about 10 to 30 out of 100 people.1 These complications include
problems with the heart, kidneys, or lungs.
Complications after the surgery include bleeding, infection, colon problems, erection problems, and problems with the repaired aneurysm.
When you need to make a decision about repairing an aortic
aneurysm, you and your doctor will consider the benefits compared to the risks. For some people, a less invasive repair procedure might be a good choice. But not everyone can have this procedure. For more information, see Endovascular Repair for Abdominal Aortic Aneurysm.
Before you have surgery, your doctor will check to see if you have other health problems that might make complications more likely. These problems include diseases of the heart, kidneys, lung, or liver. Smoking and high blood pressure also put a person at a higher risk for
complications from surgery.
Complete the surgery information form (PDF)surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.
Isselbacher EM (2008). Abdominal aortic aneurysms
section of Diseases of the aorta. In P Libby et al., eds., Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 8th ed., pp. 1458–1469. Philadelphia: Saunders
Hirsch AT, et al. (2006). ACC/AHA 2005 practice
guidelines for the management of patients with peripheral arterial disease
(lower extremity, renal, mesenteric, and abdominal aortic): A collaborative
report from the American Association for Vascular Surgery/Society for Vascular
Surgery, Society for Cardiovascular Angiography and Interventions, Society for
Vascular Medicine and Biology, Society of Interventional Radiology, and the
ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop
Guidelines for the Management of Patients With Peripheral Arterial Disease):
Endorsed by the American Association of Cardiovascular and Pulmonary
Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular
Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease
Foundation. Circulation, 113(11): e463–e654.
Rooke TW, et al. (2011). 2011 ACCF/AHA Focused update of the guideline for the management of patients with peripheral artery disease (updating the 2005 guideline): A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology, 58(19): 2020–2045.
Eliason JL, Upchurch GR Jr (2008). Endovascular abdominal aortic aneurysm repair. Circulation, 117(13): 1738–1744.
February 22, 2012
E. Gregory Thompson, MD - Internal Medicine & David A. Szalay, MD - Vascular Surgery
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