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Open Repair Surgery for Abdominal Aortic Aneurysm

Surgery Overview

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.

What To Expect

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.footnote 1

Why It Is Done

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.footnote 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:footnote 3

  • The shape and location of your aneurysm.
  • Your age and overall health, to make sure that you are healthy enough for a surgery.
  • If you are able and willing to have the yearly tests that are needed after endovascular repair. Testing is done less often after an open repair.

How Well It Works

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.footnote 4

Risks

Most people who have open repair surgery recover well. But this surgery has serious risks during surgery and soon after surgery.

About 5 out of 100 people die during surgery or within 30 days.footnote 4 This risk may depend on your health before surgery and where the aneurysm is located.

About 9 to 17 out of 100 people have complications during the surgery or within 30 days.footnote 5 These complications include problems with the heart, kidneys, or lungs.

Complications after the surgery include bleeding, infection, colon problems, and problems with the repaired aneurysm.

What To Think About

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.

References

Citations

  1. Braverman AC, et al. (2012). Diseases of the aorta. In RO Bonow et al., eds., Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 9th ed., vol. 2, pp. 1309-1337. Philadelphia: Saunders.
  2. 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.
  3. 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.
  4. Lederle FA, et al. (2007). Systematic review: Repair of unruptured abdominal aortic aneurysm. Annals of Internal Medicine, 146(10): 735-41. DOI: 10.7326/0003-4819-146-10-200705150-00007. Accessed December 22, 2016 .
  5. Schermerhorn ML, et al. (2008). Endovascular vs. open repair of abdominal aortic aneurysms in the Medicare population. New England Journal of Medicine, 358(5): 464-474. DOI: 10.1056/NEJMoa0707348. Accessed December 22, 2016.

Other Works Consulted

  • Braverman AC, et al. (2012). Diseases of the aorta. In RO Bonow et al., eds., Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 9th ed., vol. 2, pp. 1309-1337. Philadelphia: Saunders.
  • 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.

Credits

ByHealthwise Staff
Primary Medical ReviewerE. Gregory Thompson, MD - Internal Medicine
Adam Husney, MD - Family Medicine
Jeffrey J. Gilbertson, MD - Vascular Surgery

Current as ofNovember 21, 2017


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