Aortic aneurysm surgery

Expert reviewer Mr Mark Yeatman, Cardiothoracic Surgeon
Next review due June 2023

Aortic aneurysm surgery is a procedure to help relieve pressure on a swollen artery to reduce the risk of it rupturing. An aortic aneurysm is when your aorta – the main artery that carries blood from your heart to the rest of your body – bulges outwards (dilates). This can happen in your chest (a thoracic aortic aneurysm, or in your tummy (abdomen), which is known as an abdominal aortic aneurysm.

If your aortic aneurysm has already ruptured, you’ll need to have emergency surgery to fix it. 

A group of surgeons with surgical gear

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
  • it’s location
  • whether there is anything that puts you at risk of your aneurysm getting 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.


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. 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 is a major cause of aneurysm growth and rupture.
  • If you have high cholesterol, take some steps to lower it.
  • Keep your blood pressure down. Eating a healthy diet, keeping active and limiting your salt and alcohol intake can help you to maintain a healthy blood pressure. But take care when exercising because intense or competitive exercise causes your blood pressure to rise temporarily and could put pressure on your aorta.

For more information, speak to your doctor.

Preparing for aortic aneurysm surgery

Your surgeon will discuss the procedure with you. Don’t be afraid to ask if you have any questions so you 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 example – if you smoke, it’s important to stop because smoking can increase your risk of getting an infection. Smoking also prevents your cuts from healing, so it slows down your recovery.

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 on if and when you need to stop eating and drinking before your operation.

Before you go into hospital, remove any nail polish or false nails. You can have a shower on the day of your surgery. It’s best not to shave any areas of skin that are being operated on as this can increase your risk of getting an infection. If you do need to shave any hair, your surgeon will explain how to do this.

Depending on the type of surgery you’re having, you’ll have either a general or local anaesthetic. Open surgery is done under general anaesthesia. If you’re having keyhole surgery, you may be able to have a local anaesthetic.

You’ll need to stay in hospital for a while after the procedure (how long can vary) so remember to prepare an overnight bag. For more information, see our Aftercare section below.

Open aortic aneurysm surgery

During open surgery, your surgeon will make 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.

Next, your surgeon will open up the damaged part of your aorta and put in a synthetic (man-made) graft (tube). This allows blood to flow through your aorta without touching the damaged parts. The graft takes the pressure off your bulging aorta so it is less likely to rupture.

Open surgery usually takes around three hours.

Keyhole aortic aneurysm surgery

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

Endovascular aortic repair (EVAR)

Another type of keyhole surgery for aortic aneurysms is called endovascular aortic repair (EVAR).

Your surgeon will make a small cut in your groin and the underlying artery (the femoral artery). They’ll then thread a thin tube into your artery and feed it up until it reaches the aneurysm. Next, your surgeon will pass the graft, 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 it’s in the right position, your surgeon will release the graft and make sure it’s sealed properly.

Keyhole surgery usually takes up to three hours but if you’re having a more complex operation, it can take longer. Sometimes it’s necessary to convert from keyhole to open surgery. Ask your surgeon how long your operation will take.

Aftercare for aortic aneurysm surgery

After your operation, you’ll be taken to ICU (the intensive care unit), or a POCCU (post-operative critical care unit), where doctors and nurses will look after you. You may stay here for around 24–48 hours, although this can vary. When you’re ready, you’ll be moved to a ward to be looked after.

You’ll have a drip to give you any fluids or medicines that you 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.

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. You may also have tubes coming from your chest that drain any fluid or oxygen that has built up around your heart or lungs.

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 will 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 (around a week to 10 days) than if you had keyhole surgery (two to three days).

When you’re ready to leave the hospital, ask family or a friend to take you home.

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Recovering for 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.

You may feel some pain and discomfort around your wound after your operation, but this should only be a temporary side-effect.

It’s important to get up and moving after your operation. However, you shouldn’t do anything strenuous or lift anything heavy for about six weeks after open surgery. Check with your hospital for specific advice.

In terms of life after aortic aneurysm surgery, what you can and can’t do will depend on the type of surgery you’ve had and your individual circumstances. Follow the advice your nurses, physiotherapists and doctors give you.

When you feel ready, start to move around and take short walks. This can help you to recover.

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

While you recover from surgery, you won’t be able to drive. 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.

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. It can be anything from a month (if you have endovascular aortic repair (EVAR) to three months (if you’ve had open surgery). Ask your surgeon for advice. 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 to help your recovery.

Complications of aortic aneurysm surgery

Complications are problems that occur during or after aortic aneurysm surgery. For both open and keyhole surgery there’s a risk of cardiovascular complications during surgery, such as a heart attack or stroke.

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 (false) aneurysm. There’s also a risk that the graft or your wound may get infected.

Open surgery for abdominal aortic aneurysm

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 tummy where the surgical cut was made. It is a type of abdominal hernia.

After surgery, some men struggle with sex. Particularly in open abdominal surgery, the blood flow and nerves in your pelvis may be disrupted and cause erectile dysfunction.

Keyhole surgery

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.

Thoracic aortic aneurysm

If you have a thoracic aortic aneurysm repaired, there’s a chance the blood flow to your spinal cord may be interrupted. If your spinal cord doesn’t recover there’s a chance of paralysis of the legs but your surgeon will do everything they can to prevent this happening.

Ask your surgeon for more information about the complications of your operation.

Frequently asked questions

  • Your surgeon will advise you on the best type of surgery for you. For some people, endovascular aortic repair (EVAR) isn’t possible because of 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, especially 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 short-term benefit of EVAR for many people. Ask your surgeon for more information.

  • 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, 10 and 15 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 endovascular aortic repair (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 our section: 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.

    If a problem is identified during one of your check-up appointments, your surgeon or doctor will advise if you need to have further tests or surgery.

  • Flying after aortic aneurysm surgery will depend on your individual circumstances so you should ask your doctor or surgeon about this. You may wish to speak to your airline and insurer too before you travel to see if they have any recommendations or requirements. It can take a while to recover from this type of surgery so before you consider flying, make sure you feel able to. For example, could you lift your cabin bag or walk comfortably around the airport?

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  • Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, June 2020
    Expert reviewer, Mr Mark Yeatman, Cardiothoracic Surgeon
    Next review due June 2023