Surgical aneurysm repair (also called "open" aneurysm repair) has long been the standard treatment to prevent aneurysms from bursting. During the procedure, an incision is made in your chest or abdomen to reach the aneurysm. The diseased part of the aorta is removed and replaced with an artificial device (called a graft) that is the same size and shape as your healthy artery. Alternatively, fabric patches may be used to strengthen the artery wall, preventing the aneurysm from growing or bursting.
Approximately 50,000 aneurysm repair surgeries are performed each year in the United States (20% to 25% of them in women).4
How do I prepare for the procedure?
Be sure your doctor knows about all medications you are taking, including prescription medication, over-the counter drugs, and any dietary or herbal supplements. Some medications, such as the blood thing drugs warfarin (Coumadin), clopidogrel (Plavix), and aspirin can increase your risk of bleeding during surgery, so you may be told to stop taking them a few days before the procedure.
If you smoke, get the help you need to quit smoking at least 2 weeks before surgery. Quitting smoking will reduce the risk of breathing and blood clot problems during and after the surgery, and protect your long-term health.
You will have standard tests including blood and urine tests, an electrocardiogram (ECG), and a chest-X-ray to give your surgeon the latest information about your health. These may be done a few days before the procedure or after you are admitted to the hospital.
You should not eat or drink after midnight the night before surgery. If you have diabetes, ask your doctor how to keep your blood sugar under control before and after the procedure. Your doctor may give you other special instructions.
What happens during the procedure?
Surgical aneurysm repair takes place in an operating room at the hospital. You will be placed on a stretcher and given a mild sedative to help you relax. A nurse will insert an intravenous (IV) line into a vein in your arm so that medications can be given during the procedure. The area where the incision is to be made will be washed, disinfected, and shaved if necessary. Surgical aneurysm repair is performed using general anesthesia, so you will not be awake during the procedure.
Once you are asleep, a tube will be passed down your windpipe and connected to a machine called a ventilator to ensure you are breathing properly. Depending on the location of the aneurysm, you may also be connected to a heart-lung machine that takes over for your heart to pump blood through your body. Another tube will be passed into your nose and down your throat to stop liquid and air from collecting in your stomach, preventing you from feeling sick and bloated when you wake up. A tube called a catheter will also be inserted into your bladder to collect urine during the operation.
The surgeon will make an incision in your chest, abdomen, or on the left side of your body to access the aneurysm. She or he will move muscle and other tissue out of the way to expose the aneurysm. Metal clamps will then be used to cut off blood flow through the aorta. The aneurysm will be cut open and any blood clots or fatty deposits will be cleaned out. An artificial replacement for your artery, called a graft, will be sewn to your aorta above and below the aneurysm. After the graft is in place, the original aorta is usually sewn up around the graft, but it may also be removed completely. The surgeon will make sure blood is flowing smoothly through the aorta and not leaking or pressing on the aneurysm. The incision will be closed with stitches or staples.
Aneurysm repair surgery usually takes between 2 and 4 hours, depending on the location of your aneurysm. Your surgeon will tell you before the operation how long you can expect the procedure to take.
What happens after the procedure?
You will be transferred to a recovery area after the procedure, where your breathing, blood pressure, and other vital signs will be continuously monitored. The incision will be checked for bleeding, swelling, or infection. When the anesthesia wears off, you will be transferred to the intensive care unit (ICU). After a few days you will move to a regular hospital room. You should expect to stay in the hospital for 7 to 10 days after surgery to repair an aortic aneurysm.
Your breathing tube will be removed when you are able to breathe on your own. Your throat and lips may be sore because of the ventilator tube. You will be encouraged to cough frequently to remove fluid from your lungs. You may be given compression stockings to wear after the surgery to prevent blood clots in your legs. Your doctor may order additional blood tests and imaging tests (such as ultrasound) to monitor your health and make sure blood is flowing properly through your new aorta.
When you are discharged from the hospital, you will be given instructions on how to take care of your incisions and receive medication (such as aspirin) to prevent blood clots. Contact your doctor immediately if you notice:
- Signs of infection of the incision, such as fever, chills, redness, swelling, or increasing pain
- Cough, chest pain, or shortness of breath
- Pain or swelling in your abdomen
- Any kind of pain that you cannot control with the pain medication you have been given
- Nausea or vomiting more than two days after you leave the hospital
- Pain, burning, or urgency when you urinate, or blood in your urine
- Signs of blood clots in the legs, such as pain or swelling
A few weeks after the surgery, you will return to the hospital for removal of the stitches and staples that closed your incision. You may also need follow-up imaging tests to make sure the aneurysm repair was successful and you are not developing another aneurysm.
Recovery after surgical aneurysm repair takes about 6 to 8 weeks. If you have an office job, you can usually return to work within a month. You will have to wait longer if you have a physically demanding job.
What are the risks of the procedure?
As with all surgical procedures, aneurysm repair does have risks. However, your doctor has concluded that the risks of the procedure are lower than the risk of the aneurysm bursting, which is usually fatal. The risk of dying during surgery to repair an aneurysm is between 2% and 8%, with a higher risk in older patients and those with other medical conditions.1
Although women are slightly more likely than men to die during the surgery (8% of women compared with 5% of men in one large database), most studies find that the procedure is just as safe in women after the patient's age and other medical conditions are taken into account.3,5-7
Possible complications after surgical aneurysm repair include:
- Infection of the incision site, or lung or urinary infections
- Excessive bleeding during or after the surgery, requiring a blood transfusion
- Blood clots that can cause a heart attack, stroke, or pulmonary embolism. You will be given medication to prevent blood clots after the surgery.
- Nerve damage that causes pain, numbness, or loss of feeling in your legs (more common in surgery for aneurysms in the upper (thoracic) aorta)
- Kidney failure