Aortic aneurysm surgery

Aortic aneurysm surgery is a procedure to repair a swollen artery (your aorta) to reduce the risk of it rupturing (breaking). If your aortic aneurysm has already ruptured, you’ll need emergency surgery to fix it.

About aortic aneurysm surgery

Your aorta is the main artery that carries blood from your heart to the rest of your body. An aortic aneurysm is when your aorta bulges outwards (dilates).

• If this happens in your chest, it’s called a thoracic aortic aneurysm.
• If it happens in your tummy (abdomen), it’s called an abdominal aortic aneurysm.
• If it happens in both your chest and tummy, this is known as a thoracoabdominal aneurysm.

An aortic aneurysm weakens the wall of your aorta. This means the wall of the aorta may break if you don’t have treatment to repair it.

Aortic aneurysm repair replaces the affected part of your artery with an artificial (synthetic) tube – this is called a graft. The graft will allow blood to flow through your aorta without touching the damaged parts. This takes the pressure off your bulging aorta so it’s less likely to rupture.

Preparation for aortic aneurysm surgery

Your surgeon will discuss the procedure with you. Don’t be afraid to ask any questions you might have, so you can feel fully informed and comfortable. You’ll be asked to sign a consent form. Your surgeon will tell you what you need to do to prepare for your surgery.

This may include the following.

• If you smoke, it’s important to stop. Smoking can increase your risk of getting an infection. It also damages your blood vessels.
• You shouldn’t do weight-lifting exercises while you’re waiting for aneurysm surgery.
• Your hospital will ask about any medicines you’re taking, including herbal medicines, supplements and contraceptive pills. They’ll advise which medicines you should continue to take and which ones to stop. Always follow their advice.
• Your hospital will give you instructions about if and when you need to stop eating and drinking before your operation.
• Depending on the type of aortic aneurysm repair surgery you’re having, you’ll have either a general anaesthetic or a local anaesthetic. Open surgery is done under general anaesthesia.
• EVAR (keyhole surgery) is usually done under local anaesthesia, but you sometimes need a general or regional anaesthetic instead.
• You’ll need to stay in hospital for a while after the procedure, so take everything you’ll need for your stay. For more information, see our section on aftercare for aortic aneurysm surgery.

Open aortic aneurysm surgery

During open surgery, your surgeon will make a large cut in the skin on your tummy to reach 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 the upper part of your body throughout your procedure.

Next, your surgeon will open up the damaged part of your aorta and put in an artificial (synthetic) graft (tube). This allows blood to flow through your aorta without touching the damaged parts. Your surgeon will then close the cut in your tummy with stitches or staples.

Open surgery usually takes around four to six hours.

Endovascular aortic repair (EVAR)

Endovascular aortic repair (EVAR) is a type of keyhole surgery for aortic aneurysms.

Your surgeon will make a small cut in your groin and the underlying artery (the femoral artery) in each leg. They’ll then thread a thin tube into your artery and feed it through until it reaches the aneurysm in your aorta. Next, your surgeon will pass the graft up through the tube in your artery to the aneurysm. Your surgeon will use X-ray images to help guide the graft into the right place. Once it’s in position, your surgeon will release the graft and make sure it’s sealed properly.

Keyhole surgery usually takes up to two hours. But if you’re having a more complex operation, it can take longer. It may be necessary to convert from keyhole to open surgery, but this rarely happens. Ask your surgeon for more information.

Aftercare for aortic aneurysm surgery

After your aortic aneurysm repair, you’ll go to the ICU (intensive care unit) or HDU (high dependency unit), where doctors and nurses will look after you. You may stay there for around 24 to 48 hours, although this can vary. When you’re ready, you’ll be moved to a ward.

You’ll have a drip to give you any fluids or medicines that you need. These may include pain-relief medicines. You may also have a catheter to drain urine from your bladder so you won’t need to go to the toilet.

You may have a tube in your nose that passes into your stomach. You may remain on a breathing machine for a short time after your operation. But you’ll be taken off this as soon as possible and you can breathe on your own.

If you had open surgery, you may have a tube from your tummy or chest to drain any blood that has collected from your wound.

Your doctors and nurses will monitor your pulse, blood pressure, body temperature and heart rhythm regularly. They’ll also check on your wound.

How long you stay in hospital can vary. It will depend on your individual circumstances and the type of surgery you’ve had. If you’ve had open surgery, you may stay in hospital longer (over a week) than if you had keyhole surgery (two to three days).

Recovery for aortic aneurysm surgery

How long it takes to recover from aortic aneurysm repair can depend on your surgery. It usually takes:

• a few weeks to recover from EVAR
• three months or more to recover from open surgery

But everyone’s different so it could take longer before you feel back to normal. Follow the advice from your nurses, physiotherapists and doctors.

You may feel some pain and discomfort around your wound after your operation, but this shouldn’t last for longer than a week.

It’s important to get up and moving after your operation. When you feel ready, start to move around and take short walks. Don’t do anything strenuous or lift anything heavy for about six weeks after open surgery. Check with your hospital for specific advice.

Your stitches may be removed while you’re still in hospital. If not, your hospital will arrange for a GP practice or district nurse to remove your stitches or staples and check your wound. If your surgeon used dissolvable stitches, they’ll disappear on their own over time (usually over four to eight weeks).

Driving and flying after your surgery

While you recover from surgery, you won’t be able to drive for several weeks. After open surgery, you may not be able to drive for six to eight weeks. For advice on when you can drive again, 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 because it could affect your policy.

When you can fly after surgery varies from person to person, so ask your doctor or surgeon. You’re usually advised to wait six to eight weeks after open surgery and two to three weeks after EVAR. It’s a good idea to speak to your airline and insurer before you travel to see if they have any recommendations or requirements.

Returning to work after your surgery

You’ll need to take time off from work after your operation. How much time you need to take off can vary and will depend on how well you recover. You can usually return to work gradually after two months, slowly increasing your hours and what you usually do at work. Ask your surgeon for advice. It’s important to speak to your employer about this or make suitable arrangements if you’re self-employed. When you feel ready, it’s important to get back to work to help your recovery.

Monitoring

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.

After open surgery, you’ll have a follow-up appointment with your surgeon. But you don’t usually need to have regular scans afterwards.

If you have endovascular aortic repair (EVAR), you’ll need regular check-ups and scans for the rest of your life. You may have these scans every year. This is to check for complications and make sure the graft stays in place and is still working properly.

Regular scans after EVAR may include:

• CT scans
• a type of ultrasound scan called a duplex scan, which shows how blood moves through your blood vessels

For more information about potential complications, see our section on complications of aortic aneurysm surgery. If you have any complications, you may need further treatment.

Complications of aortic aneurysm surgery

Complications are problems that happen during or after the repair surgery. For both open and keyhole surgery, there’s a risk of:

• a heart attack or stroke
• kidney damage
• blood not flowing properly through the graft to your lower body
• another aneurysm may form after surgery, called a false (pseudo) aneurysm
• the graft or your wound may get infected
Open surgery for abdominal aortic aneurysm

If you have open surgery for an abdominal aortic aneurysm, you could get an incisional hernia. This is when part of your bowel pushes through your tummy where the surgical cut was made. It’s a type of abdominal hernia.

After surgery, some men struggle with sex. The blood flow and nerves in your pelvis may be affected and cause problems in getting an erection (erectile dysfunction). This may happen after EVAR too.

EVAR (keyhole surgery)

Risks after keyhole surgery can include:

Thoracic aortic aneurysm

If you have a thoracic aortic aneurysm repaired, the blood flow to your spinal cord may be interrupted. If your spinal cord doesn’t recover, there’s a chance of paralysis of your legs. But your surgeon will do everything they can to prevent this happening. For more information about complications related to your surgery, speak to your doctor.

Alternatives to aortic aneurysm surgery

Watchful waiting

If your aortic aneurysm is small (under 5.5cm in men and under 5cm in women), your doctor won’t usually suggest you have surgery. But this can vary depending on:

• the cause of your aneurysm
• where it is
• if your aneurysm is more likely to get bigger – for example, 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 get bigger and is at risk of rupturing, your doctor may recommend surgery. This planned surgery is known as elective surgery.

Self-help

If you don’t need to have surgery, you can do several things to reduce your risk of needing surgery in the future. It’s a good idea to aim for a healthy lifestyle, including eating a healthy diet and maintaining a healthy weight. Other things you can do include the following.

• If you smoke, stop smoking. Smoking is the major cause of aneurysm growth and aortic aneurysm rupture.
• If you have high cholesterol, take some steps to lower it.
• Keep your blood pressure down. This means eating a healthy diet, keeping active and limiting your salt and alcohol intake. But take care when exercising because intense or competitive exercise may cause your blood pressure to rise temporarily. This could put pressure on your aorta.

For more information, speak to your doctor.