Open surgery to repair an abdominal aortic aneurysm is sometimes done as an emergency procedure when there is any bleeding inside your body from the aneurysm.
You may also have an abdominal aortic aneurysm that is not causing any symptoms or problems. Your doctor may have found out about this problem from tests called ultrasound or CT scan. There is a risk that this aneurysm may suddenly break open (rupture) if you do not have surgery to repair it. However, surgery to repair the aneurysm may also be risky, depending on your overall health.
You and your doctor must decide whether the risk of having this surgery is smaller than the risk of rupture if you do not have the surgery. The doctor is more likely to recommend surgery if the aneurysm is:
Larger (about 2 inches or 5 cm)
Growing more quickly (a little less than 1/4 inch over the last 6 to 12 months)
The risks for this surgery are higher if you have:
Infection, including in the lungs (pneumonia), urinary tract, and belly
Reactions to medicines
Risks for this surgery are:
Bleeding before or after surgery
Damage to a nerve, causing pain or numbness in the leg
Damage to your intestines or other nearby organs
Infection of the graft
Injury to the ureter, the tube that carries urine from your kidneys to your bladder
Lower sex drive or inability to get an erection
Poor blood supply to your legs, your kidneys, or other organs
Spinal cord injury
Wound breaks open
Before the Procedure
Your doctor will do a thorough physical exam and tests before you have surgery.
Always tell your doctor or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.
If you are a smoker, you should stop smoking at least 4 weeks before your surgery. Your doctor or nurse can help.
During the 2 weeks before your surgery:
You will have visits with your doctor to make sure medical problems such as diabetes, high blood pressure, and heart or lung problems are being treated well.
You may be asked to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), clopidogrel (Plavix), naprosyn (Aleve, Naproxen), and other drugs like these.
Ask your doctor which drugs you should still take on the day of your surgery.
Always let your doctor know about any cold, flu, fever, herpes breakout, or other illness you may have before your surgery.
Do NOT drink anything after midnight the day before your surgery, including water.
On the day of your surgery:
Take the drugs your doctor told you to take with a small sip of water.
Your doctor or nurse will tell you when to arrive at the hospital.
After the Procedure
Most people stay in the hospital for 5 to 10 days. During a hospital stay, you will:
Be in the intensive care unit (ICU), where you will be monitored very closely right after surgery. You may need a breathing machine during the first day.
Have a urinary catheter
Have a tube that goes through your nose into your stomach to help drain fluids for 1 or 2 days. You will then slowly begin drinking, then eating.
Receive medicine to keep your blood thin
Be encouraged to sit on the side of the bed and then walk
Wear special stockings to prevent blood clots in your legs
Be asked to use a breathing machine to help clear your lungs
Receive pain medicine into your veins or into the space that surrounds your spinal cord (epidural)
Full recovery for open surgery to repair an aortic aneurysm may take 2 or 3 months. Most people make a full recovery from this surgery.
Most people who have an aneurysm repaired before it breaks open (ruptures) have a good outlook.
Gloviczki P, Ricotta JJ II. Aneurysmal vascular disease. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 65.
De Bruin JL, Baas AF, Buth J, Brinssen M, Verhoeven EL, Cuypers PW, et al: DREAM Study Group. Long-term outcome of open or endovascular repair of abdominal aortic aneurysm. N Engl J Med; 2010:362:1881-1889.
United Kingdom EVAR Trial Investigators, Grenhalgh RM, Brown LC, Powell JT, Thompson SG, Epstein D, Sculpher MJ. Endovascular versus open repair of abdominal aortic aneurysm. N Engl J Med; 2010;362:1863-1871.
Shabir Bhimji, MD, PhD, Specializing in General Surgery, Cardiothoracic and Vascular Surgery, Midland, TX. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.