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Aortic aneurysm surgery

Aortic aneurysm surgery is surgery to help relieve pressure on an abnormally swollen artery in order to reduce the risk of it rupturing. There are two main types of surgery to treat an aortic aneurysm: open and keyhole surgery.

You might not need to have surgery. But if you do, the information here may help. Your procedure may differ from what’s described, so it’s important to speak to your surgeon. Remember to ask any questions and talk through any concerns you might have.

surgeons gathered around

About aortic aneurysm surgery

An aortic aneurysm is when your aorta – the main artery that carries blood from your heart to the rest of your body – bulges outwards. This can happen in your chest, known as a thoracic aortic aneurysm, or in your abdomen (tummy), which is known as an abdominal aortic aneurysm.

The aim of surgery is to help relieve pressure on a swollen artery to reduce the risk of it rupturing. If your aneurysm has already ruptured, you’ll need to have emergency surgery to fix it.

Alternatives to aortic aneurysm surgery

Watchful waiting

If your aortic aneurysm is small (under 5.5cm), your doctor won’t usually suggest having surgery. Although, this can vary depending on:

  • the cause of your aneurysm
  • it’s location
  • whether you do, or have, anything that puts you at risk of your aneurysm getting bigger, for example if you smoke

If you don’t have surgery, you’ll be monitored to make sure your aneurysm doesn’t get any bigger. If it does, and is at risk of rupturing, your doctor will recommend surgery. This surgery is planned and is known as elective surgery.

Self-help

If you don’t need to have surgery, there are things you can do to reduce your risk of needing to have it in the future.

  • If you smoke, stop. Smoking is a major cause of aneurysm growth and rupture.
  • Lower your cholesterol. For more information and tips, see our information on treatment for high cholesterol
  • Keep your blood pressure down. You may be able to achieve this by making changes to your lifestyle such as eating healthily and staying active. See our information on treating high blood pressure for more lifestyle changes and other ways to keep your blood pressure under control. If you have an aortic aneurysm, take care when exercising. Intense or competitive exercise causes your blood pressure to rise temporarily and could put pressure on your aorta.

For more information or help, speak to your doctor.

Preparing for aortic aneurysm surgery

Your surgeon will discuss the procedure with you. You’ll be able to ask any questions so that you’re well informed and in a position to give consent for the procedure to go ahead. You’ll be asked to sign a consent form, so it’s important that you understand what’s involved. Your surgeon should discuss these with you, but it may help to ask about the following.

  • Alternatives – are there any alternatives? If so, what are they? See our Alternatives section above for more information.
  • Benefits – do I need to have this operation? What are the benefits?
  • Success – How likely is it that the operation will be successful?
  • Risks – are there any side-effects of the operation or possible complications? See our sections below: Side-effects and Complications for more information.
  • Further treatment – will I need to have follow-up treatment or tests after the operation? See our FAQ: What follow-up will I need after surgery? for more information.

If you decide to go ahead with the procedure, your surgeon will tell you what you need to do to prepare. For example, if you smoke you’ll be asked to stop. This is because smoking can increase your risk of getting an infection. It also prevents your cuts from healing, overall slowing down your recovery.

Your surgeon will also discuss any medicines that you’re taking – this includes herbal medicines, supplements and contraceptive pills. Some medicines can cause problems during surgery, so it’s important that you tell your surgeon everything. They’ll advise which medicines you should continue to take and which ones to stop. For more information, talk to your surgeon and remember to always follow their advice.

Before the operation you should, remove any nail polish or false nails and have a bath or shower a day before, or on the day of your surgery. Remember not to shave any areas of skin that are being operated on as this can increase your risk of getting an infection. If hair needs to be removed, your surgeon will explain how to do this.

Depending on the type of surgery, you’ll have either a general or local anaesthetic. Open surgery is done under a general anaesthetic. If you’re having keyhole surgery, you may be able to have a local anaesthetic. Your surgeon will discuss this with you to make sure you’re comfortable and understand what’s involved. For example, you may need to follow fasting instructions. This means not eating or drinking for a certain amount of time before your surgery.

It’s important to follow your surgeon’s advice as it may differ from what’s described here. In general, you’ll usually be advised to stop eating a minimum of six hours before your surgery. You’ll usually be able to drink water up until two hours before.

You’ll need to stay in hospital for a while after the procedure, so remember to prepare an ‘overnight’ bag. How long you’ll stay in hospital may vary. See our section: Aftercare for more information.

The procedure: open aortic aneurysm surgery

During open surgery, your surgeon makes a large cut in your skin to access your aorta. They’ll put clamps around your aorta to stop blood flowing through it while they operate. Even though your aorta is clamped, your surgeon will make sure that blood and oxygen continue to circulate around your body at all times.

Your surgeon opens up the damaged part of your aorta and puts in a synthetic (manmade) graft. The graft is tube-shaped. When inserted into your aorta and sealed up, it allows blood to flow though it without touching the damaged parts. This takes pressure off the bulging parts of your aorta, making them less likely to rupture.

Rather than making a large cut, your surgeon may make a smaller cut and use special equipment to help them operate on your aorta. This is known as laparoscopic surgery. For more information, speak to your surgeon.

You can watch an animation to see how open abdominal aortic surgery is done.



The procedure: keyhole aortic aneurysm surgery

Keyhole surgery for aortic aneurysms may also be referred to as endovascular aortic repair (EVAR).

During this procedure, your surgeon will make a small cut in your groin and underlying artery (called the femoral artery). They’ll insert a thin tube into your artery and feed it up until it reaches the aneurysm.

Your surgeon will then pass a stent, which is pre-loaded onto a special piece of equipment, up through your artery to where the aneurysm is. Your surgeon will use X-ray images to help guide the graft into the correct place. Once in the correct position, your surgeon will release the graft and make sure it’s sealed properly.

Under certain circumstances your surgeon may have to convert from keyhole to open surgery. For more information, speak to your surgeon.

You can watch an animation to see how keyhole abdominal aortic aneurysm surgery is carried out.



Aftercare for aortic aneurysm surgery

After your operation, you may be taken to ICU (the intensive care unit), or a POCCU (post-operative critical care unit), where your doctors and nurses will look after you. You may stay here for around 24–48 hours, although this can vary from one person to the next.

When you’re ready, you’ll be moved to a ward to be looked after.

After your surgery, you’ll have a drip so that your doctors and nurses can give you any fluids or medicines that you might need. These may include pain relief medicines. You’ll also have a catheter to drain urine from your bladder, so you won’t need to go to the toilet to wee.

You may have a tube inserted into your nose, passing into your stomach (a naso-gastric tube). You’ll be given oxygen through a mask to help with your breathing. If you’ve had surgery for a thoracic aortic aneurysm, you may initially have a tube in your mouth to help you breath. When you can breathe on your own, the tube will be removed and replaced with an oxygen mask. You may also have tubes coming from your chest that drain any fluid or oxygen that has built up around your heart or lungs.

If you’ve had surgery for an abdominal aortic aneurysm, you’ll have a tube from your tummy (abdomen) to drain collected blood from your wound.

Your doctors and nurses will do everything they can to help you stay as safe and comfortable as possible. They’ll monitor your pulse, blood pressure, body temperature and heart rhythm regularly and check on your wound.

How long you stay in hospital can vary. It’ll depend on lots of different things including, for example, the type of surgery you’ve had. People who have open surgery tend to stay in hospital longer than those who have keyhole surgery. On average, people who’ve had open surgery on an aortic aneurysm stay in hospital for around nine to 10 days and those who have keyhole surgery stay for around four to five days. However, this could be longer or shorter depending on your individual circumstances.

When you’re ready to leave the hospital, make sure you arrange for someone to take you home.

Recovering from aortic aneurysm surgery

It’s hard to say how long it takes to recover from surgery. It could take several weeks or even months before you’re feeling back to normal.

The cut on the surface of your skin may appear to have healed after a couple of weeks, but the wound itself and underlying muscle may take six to eight weeks to heal completely. Although it’s important to get up and moving after your operation, you should avoid doing anything too strenuous or lifting anything heavy until your wound has completely healed.

What you can and can’t do will depend on the type of surgery you’ve had and your individual circumstances. Be guided by your nurses, physiotherapists and doctors and always follow their advice.

When you feel ready, moving around and taking short walks can help you to recover – it may even help with constipation too. Constipation is common after surgery; for self-help tips see our Constipation information. You may be able to feel your wound pulling, but it’s important that you stand up straight and move as normal to help your wound heal properly.

Your stitches will be removed around seven to 10 days after your operation. If your surgeon used dissolvable stitches, you won’t need to have these removed as they’ll disappear on their own over time.

While you recover from surgery, you won’t be able to drive. When you feel ready to start driving again, it’s important that you make sure you have full control of your vehicle. This is your responsibility, so it’s worth sitting in your car with the engine switched off and going through the motions. Can you lift both feet off the floor to do an emergency stop? Are you able to navigate the gear stick and handbrake comfortably? For more advice, contact the Driver and Vehicle Licensing Agency (DVLA) or speak to your doctor. You may need to tell your insurer that you’ve had surgery as it could affect your policy.

You may also need to take time off from work after your procedure. How much time you need to take may vary and will depend on how well you recover. It’s important to speak to your employer about this, or make arrangements if you’re self-employed. When you feel ready, it’s important to get back to work.

Dr Jenny Lesser, Consultant Occupational Physician says, “It’s normal to feel a little anxious about going back to work after being off sick, especially if you’ve been off for quite a while. But it’s good to know that getting back to work can actually help you recover and avoid long-term illness.” You can find out more from Jenny on her blog: How to get back to work after sick leave.

Side-effects of aortic aneurysm surgery

Side-effects are the unwanted, but mostly temporary effects you may get after the operation. After surgery you may:

  • have pain and discomfort around your wound
  • find it difficult to poo (ie you have constipation)
  • have discomfort or difficulty passing urine if you’ve had a catheter inserted during your surgery

For more information on side-effects, speak to your doctor.

Complications of aortic aneurysm surgery

Complications are problems that occur during or after the procedure. For both open and keyhole (or EVAR) surgery there’s a risk of cardiovascular complications during surgery, such as a heart attack or stroke. However, the risk is lower in keyhole surgery – only between one and five in every 100 people who have this type of surgery are affected.

There’s a risk that blood won’t be able to flow properly through the graft to your lower body, or that another aneurysm may form after surgery. This is known as a pseudo – or false – aneurysm.

There’s also a risk that the graft or your wound may become infected.

If you have open surgery for an abdominal aortic aneurysm, there’s a risk that you could get an incisional hernia. This is when part of your bowel pushes through your abdomen where the surgical cut was made. You can find out more on our page: Abdominal hernia.

After surgery, some men struggle with sex. Particularly in open abdominal surgery, blood flow and nerve stimulation to the pelvis may be disrupted and cause erectile dysfunction. You can learn more about erectile dysfunction on our Male infertility page.

Risks after keyhole surgery may include:

  • endoleaks – this is when blood leaks through the graft into the damaged part of the aorta
  • movement of the graft overtime
  • sac enlargement – the weak part of your aorta may continue to grow despite surgery because of an endoleak

For more information about complications related to your surgery, speak to you doctor.

FAQ: Can I opt to have keyhole over open surgery?

Your surgeon will advise you about whether open or keyhole (EVAR) surgery will be better for you. EVAR isn’t suitable for everybody. For some people, EVAR isn’t possible due to the location or shape of the aneurysm or the size of the arteries in their groin. Even for those people who are suitable, open surgery may still be considered the better option. This may be especially true for those who are young and otherwise fit. This is because you need life-long follow-up after EVAR and there’s a greater risk of needing further treatment. This may outweigh the small short-term benefit of having this type of procedure for many people. Ask your surgeon for more information.

FAQ: What follow-up will I need after surgery?

After your procedure, you’ll have follow-up appointments and tests to see how you’re getting on. How often you need these depends on the type of surgery you have.

Open surgery is thought to be durable – it withstands the ‘test of time’ and there’s often little need for further treatments and procedures. In the long term, you’ll need to have scans at regular intervals (perhaps every five, ten and fifteen years) to check for complications. These scans may include CT (computed tomography) scans or a special type of ultrasound scan called a duplex scan. This scan shows how blood moves through your blood vessels.

If you have keyhole (EVAR), you’ll need regular check-ups for the rest of your life. To begin with, you’ll usually need to have a follow-up CT angiogram (CTA) and X-ray about a month after your procedure.

A CT angiogram is a type of CT scan that uses a special dye to show up your blood vessels. If your graft looks fine and there’s no sign of an endoleak (see Complications above), you’ll have a CTA a year later to check everything is still OK. You’ll then continue to have scans, including a duplex ultrasound and X-ray each year after this.

If there’s an endoleak or a potential fault with your graft, you’ll need to have a CTA scan six months and a year after your procedure. You’ll then continue to have a CTA and X-ray each year after this to make sure everything is OK.

For more information, speak to your surgeon or doctor. If a problem is identified during one of your check-up appointments, they’ll be able to advise if you need to have further tests or surgery.

FAQ: Can you fly after surgery?

Whether you can, and how soon after surgery you can fly will depend on your individual circumstances. You’ll need to speak to your doctor or surgeon about this. It’s also advisable to speak to your airline and insurer before you travel to see if they have any specific recommendations or requirements. It’s important to remember that it takes a while to recover from this type of surgery (see Recovery above), so before you consider flying make sure you feel able. If needed, could you lift your cabin bag, or walk comfortably around the airport?

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    Further information

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    Reviewed by Laura Blanks, Specialist Health Editor, Bupa Health Content Team, November 2017
    Expert reviewer Mr Mark Yeatman, Cardiothoracic Surgeon
    Next review due November 2020

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