Aortic aneurysm surgery
Your health expert: Mr Said Abisi, Consultant Vascular Surgeon and Endovascular Surgeon
Content editor review by Rachael Mayfield-Blake, Freelance Health Editor, October 2022.
Next review due October 2025.
Aortic aneurysm surgery is a procedure to repair a swollen artery (your aorta) to reduce the risk of it rupturing. If your aortic aneurysm has already ruptured, you’ll need to have emergency surgery to fix it.
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 (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. It can also happen in both your chest and abdomen, this is known as a thoracoabdominal aneurysm.
An aortic aneurysm weakens the wall of your aorta so it may break if you don’t get treatment to repair it.
Aortic aneurysm surgery replaces the affected part of your artery with an artificial (synthetic) tube (graft). This will allow blood to flow through your aorta without touching the damaged parts. The graft will take 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, which may include the following.
- If you smoke, it’s important to stop because smoking can increase your risk of getting an infection. Smoking also damages your blood vessels.
- 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 surgery you’re having, you’ll have either a general or local anaesthetic.
- Open surgery is done under general anaesthesia.
- Keyhole surgery can be done under local anaesthesia.
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.
Open aortic aneurysm surgery
During open surgery, your surgeon will make a large cut in the skin on your tummy 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 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.
Open surgery usually takes around four hours.
How open abdominal aortic aneurysm surgery is carried out
Animation |Aortic aneurysm Repair through open abdominal surgery | Watch in 1:33 mins
This type of surgery is carried out to repair an aneurysm in the aorta (the largest blood vessel in your body) to stop it from bursting.
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). They’ll then thread a thin tube into your artery and feed it up until it reaches the aneurysm in your aorta. Next, your surgeon will pass the graft, which is pre-loaded onto a 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 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.
EVAR isn’t suitable for everyone. For some people, EVAR isn’t possible because of the location or shape of the aneurysm or the size of the arteries in their groin. Even if EVAR is suitable for you, open surgery may still be considered as an alternative option, especially if you’re young and otherwise fit. This is because you need check-ups for the rest of your life after EVAR, and there’s a greater chance of needing further treatment. This may outweigh the benefit of EVAR for many people. Ask your surgeon for more information.
How keyhole abdominal aortic aneurysm surgery is carried out
Animation |Abdominal aortic aneurysm repair through keyhole surgery | Watch in 1:46 mins
Abdominal aortic aneurysm is a widening or bulging of the aorta (the largest blood vessel) in the abdomen.
Aftercare for aortic aneurysm surgery
After your aortic aneurysm repair, you’ll go to ICU (the 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).
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Recovery for aortic aneurysm surgery
How long it takes to recover from aortic aneurysm repair can vary. It usually takes around two weeks to recover from EVAR and three months from open surgery. But it could take longer before you feel back to normal, depending on your individual circumstances. Follow the advice your nurses, physiotherapists and doctors give you.
- You may feel some pain and discomfort around your wound after your operation, but this shouldn’t last long (no 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 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.
Returning to work after aortic aneurysm 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. 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 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 need to have scans at regular intervals (perhaps every five years) to check for complications. For more information about potential complications, see our section on complications of aortic aneurysm repair surgery. Scans may include CT (computed tomography) scans or a 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. This is to check for complications, and to make sure the graft stays in place and is still working properly (you may need further treatment if not). To begin with, you’ll usually need to have a follow-up CT angiogram (CTA) and X-ray about a month after your procedure. You’ll need an ultrasound every year.
Complications of aortic aneurysm surgery
Complications are problems that happen during or after aortic aneurysm repair. For both open and keyhole surgery, there’s a risk during the procedure of cardiovascular complications such as a heart attack or stroke.
There’s also 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 false (pseudo) 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’s a type of abdominal hernia.
After surgery, some men struggle with sex. Particularly in open surgery, the blood flow and nerves in your pelvis may be affected and cause problems in getting an erection (erectile dysfunction).
Keyhole surgery
Risks after keyhole surgery can include:
- endoleaks – this is when blood leaks through the graft into the damaged part of the aorta
- sac enlargement – the weak part of your aorta may continue to grow despite surgery because of an endoleak
- movement of the graft over time
For more information about complications related to your surgery, speak to your doctor.
Thoracic aortic aneurysm
If you have a thoracic aortic aneurysm repaired, it’s possible that 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.
Ask your surgeon for more information about the complications of your operation.
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
- if 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.
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. 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. Eat a healthy diet, keep active and limit your salt and alcohol intake to help you to maintain a healthy blood pressure. But take care when exercising because intense or competitive exercise may cause your blood pressure to rise temporarily, which could put pressure on your aorta.
For more information, speak to your doctor.
What follow-up appointments you need after aortic aneurysm repair will depend on the type of surgery you have. If you have open surgery, you’ll need to have scans around every five years to check for any complications. If you have endovascular aortic repair (EVAR), you’ll need regular check-ups for the rest of your life. The first will be about a month after your procedure.
For more information, see our section: Recovery for aortic aneurysm surgery.
It will depend on your individual circumstances so ask your doctor or surgeon. It’s a good idea to speak to your airline and insurer before you travel to see if they have any recommendations or requirements. It can take a while to recover from aortic aneurysm 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?
For more information, see our section: Recovery for aortic aneurysm surgery.
How long the recovery from aortic aneurysm surgery takes can vary. It’s usually around two weeks to recover from EVAR and three months from open surgery. But it could take longer before you feel back to normal. Ask your doctor how long they think it will take for you to recover.
For more information, see our section: Recovery for aortic aneurysm surgery.
How long you stay in hospital after aortic aneurysm repair can vary depending on your individual circumstances and the type of surgery you have. 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).
For more information, see our section: Aftercare for aortic aneurysm surgery.
In the UK, when an aortic aneurysm measures 5.5cm or more in men, and 5cm or more in women, surgery is recommended. Your doctor will also likely suggest you have an aortic aneurysm repaired if it’s 4cm or more and growing rapidly (more than 1cm in a year). The decision on if you can have an operation will also depend on your general health, and if you wish to have the operation.
For more information, see our section: Alternatives to aortic aneurysm surgery.
If you have an aortic aneurysm and aren’t having surgery, the most important thing is not to smoke. Aim to have a healthy lifestyle, including eating a healthy diet and maintaining a healthy weight. But take care when you exercise because intense or competitive exercise may cause your blood pressure to rise temporarily and put pressure on your aorta.
For more information, see our section: Alternatives to aortic aneurysm surgery.
If you have an aortic aneurysm, there are things you can do to reduce your chance of needing to have an operation in the future. A healthy diet is a part of this. Eat at least five portions of fruit and vegetables a day and eat plenty of fibre. Try to eat fewer unhealthy foods that include refined sugars, salt and saturated fat. You could try to include more mono-unsaturated fat like olive oil.
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