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Abdominal aortic aneurysm repair - open

Open abdominal aortic aneurysm repair is surgery to fix a widened part in your aorta, 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. 

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's 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 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. 

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. 

Alternative Names

AAA - open; Repair - aortic aneurysm - open

Why the Procedure Is Performed

Open surgery to repair an abdominal aortic aneurysm is sometimes done as an emergency procedure when there is bleeding inside your body from the aneurysm. 

You may have an abdominal aortic aneurysm that is not causing any symptoms or problems.  Your doctor 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 doctor must decide whether the risk of having this surgery is smaller than the risk of rupture.  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)

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 carefully examine you and order 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 well treated. 

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 tell your doctor 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 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. 

For help in finding a doctor or health service that suits your needs, call the UPMC Referral Service at 412-647-UPMC (8762) or 1-800-533-UPMC (8762).  Select option 1. 

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