Open surgery is the standard, conventional type of surgery used to repair an aneurysm in your aorta (the largest blood vessel in your body). An aneurysm is a widening or bulging of your aorta. Surgery can either be planned to stop an aneurysm from bursting, or as emergency surgery to repair it.
You will meet the surgeon carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.
An abdominal aortic aneurysm is a widening of the aorta in your abdomen (tummy), often at a weak spot in the wall of your aorta. A thoracic aneurysm is a widening of the aorta in your chest. If an aneurysm bursts (ruptures), it can be fatal.
In open surgery for an aortic aneurysm, your surgeon will open your abdomen or your chest to access your aorta and will insert a graft into the weak area of your aorta. The aim is to prevent an aneurysm getting bigger or to repair it in an emergency.
The risks of open surgery are serious so your doctor or surgeon will usually only recommended that you have it if the chance of your aneurysm rupturing is high enough to justify these risks.
You may not have any symptoms of an aneurysm, unless it’s large or growing quickly.
If you're a man over 65, you’re likely to be invited to be screened for an abdominal aortic aneurysm at your GP surgery or local hospital. The UK screening programme only covers abdominal aortic aneurysms, not thoracic aortic aneurysms. Ask your GP for more information.
Your doctor or surgeon will advise you to have elective (planned) surgery if your aneurysm is:
You will need to have emergency surgery if your aneurysm ruptures.
If your aneurysm isn’t very large (less than 5.5cm) your doctor or surgeon may advise you to not have any treatment but to monitor your condition.
Your surgeon may suggest that you have the procedure using keyhole surgery but this isn't suitable for everybody – ask your surgeon if it’s an option for you.
Alternatively, your surgeon may suggest another surgical method called endovascular aneurysm repair (EVAR). However, this method isn't suitable for everyone. It depends on several factors, including the shape of your aneurysm, how near it is to other blood vessels and whether the arteries in your groin are large enough for the stent graft and the delivery device to be inserted.
Your surgeon will advise you which procedure is best for you.
Your surgeon will explain how to prepare for your operation. For example, if you smoke you will be asked to stop, as smoking increases your risk of getting a chest and wound infection, which can slow your recovery.
Open surgery for an aneurysm usually requires a hospital stay of around a week and is done under general anaesthesia. This means you will be asleep during the operation. You will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it's important to follow your anaesthetist's advice.
You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs.
Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.
Open surgery can take around two to three hours or longer, but this will depend on your individual circumstances. Ask your surgeon for advice.
Your surgeon will make a cut in your chest or your abdomen, depending on where your aneurysm is. He or she will then open the aorta close to the aneurysm and insert a graft. The graft will be synthetic and made out of an elastic material.
The graft will fit into the portion of the aorta that is damaged. Your blood will then flow through the graft, which means there will be less pressure on the damaged wall of your aorta.
The cut will be closed with either stitches, which may be dissolvable, or clips.
After your operation, you may be taken to an intensive care unit (ICU) or a high dependency unit (HDU), where you will be closely monitored for a day or two. You may have a tube in your mouth, which will pass into your windpipe (trachea) and will be connected to a ventilator (a machine to help you breathe). This will be removed once you're alert and can breathe by yourself.
You may need pain relief to help with any discomfort as the anaesthetic wears off.
You may have a catheter to drain urine from your bladder into a bag. You may also have fine tubes running out from your wound. These drain fluid into another bag and are usually removed after a day or two.
Once you’re stable, you will be taken back to a lower dependency ward, where nurses will continue to monitor you until you're ready to be discharged from hospital.
If you have dissolvable stitches, the length of time they will take to disappear depends on the type you have. They usually disappear within a couple of months.
When you're ready to go home, you will need to arrange for someone to drive. Try to have a friend or relative stay with you for the first 24 hours.
Your nurse will give you some advice about caring for your healing wound before you go home. You may be given a date for a follow-up appointment.
It usually takes at least six weeks to make a full recovery from this operation, but this varies between individuals, so it's important to follow your surgeon's advice. You may be off work for about six to 12 six weeks.
You will probably feel tired for several weeks after the operation, but this will gradually improve.
If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.
As with every procedure, there are some risks associated with aortic aneurysm open surgery. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.
Side-effects are the unwanted but mostly temporary effects you may get after having the procedure.
After open surgery for an aortic aneurysm, your healing wound will feel sore and it may leak fluid. This usually clears after a few days.
Complications are when problems occur during or after the operation.
The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in your leg (deep vein thrombosis, DVT).
Specific complications of open surgery for aortic aneurysm can include:
Produced by Rachael Mayfield-Blake, Bupa Health Information Team, June 2012.
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