Open Surgery for Aortic Aneurysms

The most common aortic aneurysms occur in the portion of the aorta that runs through the abdomen; these aneurysms are called abdominal aortic aneurysms (AAAs). Aneurysms that develop in the section of the aorta that runs through the chest are known as thoracic aortic aneurysms (TAAs). Another type of aneurysm called a thoracoabdominal aortic aneurysm (TAAA), which extends through the chest and abdominal regions of the aorta.

Open surgical repair of an aortic aneurysm requires an incision in the chest or abdomen so the surgeon can see the aneurysm. The surgeon removes the damaged part of the aorta and replaces it with a synthetic fabric tube. The procedure is performed in an operating room under general anesthesia. The main purpose of open surgery is to prevent life-threatening complications such as rupture and dissection (tearing). Open surgery can also be used to repair damage after a tear or rupture.

Who Needs Open Surgery for an Aortic Aneurysm?

Emergency open surgery is needed when an aortic aneurysm tears or ruptures. Some people require open surgery if they have an AAA, TAA or TAAA that is at risk of rupture or dissection, particularly if the aneurysm is large, small but growing at a fast rate, or causing symptoms.

Open surgery is often a good option for people who are not eligible for minimally evasive endovascular aneurysm repair (EVAR). For example, if the stent graft used in the EVAR procedure doesn’t fit the shape of a person’s aorta, they may need open surgery instead.

Benefits of Open Surgery for Aneurysm Repair

When an aortic aneurysm is at risk of rupturing, the benefits of repairing it with surgery often outweigh the risks. Surgery can help a person live longer, lowering the risk of future rupture. After recovery, the majority of patients who have open surgical repair of a large aortic aneurysm feel better than they did before the procedure, are able to breathe more freely and resume most regular activity.

Risks of Open Surgery for Aneurysm Repair

Like any major surgery, open aortic aneurysm repair surgery carries certain risks, although its benefits generally outweigh the risks. Your provider will discuss your options with you and determine if you need open surgery.

Possible risks and complications of open aortic aneurysm surgery include:

• Bleeding
• Blood clots
• Breathing problems
• Heart attack or stroke
• Infection in the graft
• Infection in the lungs, urinary tract or belly
• Kidney failure
• Damage to intestines or other organs
• Nerve damage
• Spinal cord injury

Your care team at University Hospitals will do everything possible to optimize the success and safety of your surgery.

University Hospitals earned a “high performance” rating – the highest rating possible – for abdominal aortic aneurysm repair in the U.S. News & World Report 2022 - 2023 “Best Hospitals” survey, which evaluated data from more than 4,500 hospitals throughout the U.S.

What Happens During Open Aortic Aneurysm Repair Surgery?

You will be given general anesthesia so that you sleep during your surgery and do not remember the procedure. The procedure typically takes three to four hours and includes the following steps:

1. Incision: The surgeon will make a long incision in your chest or abdomen. The exact location of the incision depends on the location of your aneurysm.
2. Clamping: To stop blood flow from above and below your aneurysm, the surgeon will apply clamps to your aorta. You will be put on a heart-lung machine that will keep your blood flowing to the rest of your body throughout the operation.
3. Graft Placement: The surgeon will replace the bulging part of your aorta with a synthetic fabric tube called a graft. The graft has strong walls to support blood flow. Your surgeon will stitch the graft to the aorta.
4. Closure: Your surgeon will close the incision in your chest or abdomen using either stitches or staples.

What Happens After Open Aortic Aneurysm Repair Surgery?

Following your surgery, you will be taken to the intensive care unit (ICU), where your care team will closely monitor your for several days before moving you to a regular hospital room.

While you’re in the hospital, your care may include:

• Blood-thinning medication (anti-coagulants).
• Compression socks to help prevent blood clots from forming in your legs.
• A urinary catheter to help you urinate.
• A drainage tube that drains fluids from your stomach.
• A machine to help you breathe until you can do so on your own.
• Pain medication.

The hospital stay for open aortic aneurysm repair surgery is typically three to 10 days. During that time, you’ll gradually begin to move around more and regain your strength.

Make arrangements for someone to drive you home from the hospital. You won’t be able to drive until your doctor says it is okay to do so.

Recovery From Open Aortic Aneurysm Repair Surgery

Some patients need to stay at a rehabilitation facility following open aortic aneurysm surgery to help them regain their independence and strength.

Your health care team will give you specific instructions to follow as you recover regarding caring for your surgical wounds, resuming appropriate levels of physical activity, pain management, making lifestyle changes and other aspects of your recovery.

Full recovery from open aneurysm surgery takes four to six weeks for most people. Some individuals may need two or three months to fully recover.