Open surgery for aortic aneurysm

How open abdominal aortic aneurysm surgery is carried out


About aortic aneurysm open surgery

An abdominal aortic aneurysm is a widening of the aorta in your abdomen (tummy), often at a weak spot in the wall of your aorta. A thoracic aneurysm is a widening of the aorta in your chest. If an aneurysm bursts (ruptures), it can be fatal.

In open surgery for an aortic aneurysm, your surgeon will open your abdomen or your chest to access your aorta and will insert a graft into the weak area of your aorta. The aim is to prevent an aneurysm getting bigger or to repair it in an emergency.

The risks of open surgery are serious so your doctor or surgeon will usually only recommended that you have it if the chance of your aneurysm rupturing is high enough to justify these risks.

Diagnosis of aortic aneurysms

You may not have any symptoms of an aneurysm, unless it’s large or growing quickly.

If you're a man over 65, you’re likely to be invited to be screened for an abdominal aortic aneurysm at your GP surgery or local hospital. The UK screening programme only covers abdominal aortic aneurysms, not thoracic aortic aneurysms. Ask your GP for more information.

Your doctor or surgeon will advise you to have elective (planned) surgery if your aneurysm is:

  • larger than 5.5cm
  • expanding by more than 1cm per year
  • causing you pain or other symptoms, such as difficulty breathing

You will need to have emergency surgery if your aneurysm ruptures.

What are the alternatives to aortic aneurysm open surgery?

If your aneurysm isn’t very large (less than 5.5cm) your doctor or surgeon may advise you to not have any treatment but to monitor your condition.

Your surgeon may suggest that you have the procedure using keyhole surgery but this isn't suitable for everybody – ask your surgeon if it’s an option for you.

Alternatively, your surgeon may suggest another surgical method called endovascular aneurysm repair (EVAR). However, this method isn't suitable for everyone. It depends on several factors, including the shape of your aneurysm, how near it is to other blood vessels and whether the arteries in your groin are large enough for the stent graft and the delivery device to be inserted.

Your surgeon will advise you which procedure is best for you.

Preparing for your aortic aneurysm open surgery

Your surgeon will explain how to prepare for your operation. For example, if you smoke you will be asked to stop, as smoking increases your risk of getting a chest and wound infection, which can slow your recovery.

Open surgery for an aneurysm usually requires a hospital stay of around a week and is done under general anaesthesia. This means you will be asleep during the operation. You will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it's important to follow your anaesthetist's advice.

You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs.

Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

What happens during aortic aneurysm open surgery?

Open surgery can take around two to three hours or longer, but this will depend on your individual circumstances. Ask your surgeon for advice.

Your surgeon will make a cut in your chest or your abdomen, depending on where your aneurysm is. He or she will then open the aorta close to the aneurysm and insert a graft. The graft will be synthetic and made out of an elastic material.

The graft will fit into the portion of the aorta that is damaged. Your blood will then flow through the graft, which means there will be less pressure on the damaged wall of your aorta.

The cut will be closed with either stitches, which may be dissolvable, or clips.

What to expect afterwards

After your operation, you may be taken to an intensive care unit (ICU) or a high dependency unit (HDU), where you will be closely monitored for a day or two. You may have a tube in your mouth, which will pass into your windpipe (trachea) and will be connected to a ventilator (a machine to help you breathe). This will be removed once you're alert and can breathe by yourself.

You may need pain relief to help with any discomfort as the anaesthetic wears off.

You may have a catheter to drain urine from your bladder into a bag. You may also have fine tubes running out from your wound. These drain fluid into another bag and are usually removed after a day or two.

Once you’re stable, you will be taken back to a lower dependency ward, where nurses will continue to monitor you until you're ready to be discharged from hospital.

If you have dissolvable stitches, the length of time they will take to disappear depends on the type you have. They usually disappear within a couple of months.

When you're ready to go home, you will need to arrange for someone to drive. Try to have a friend or relative stay with you for the first 24 hours.

Your nurse will give you some advice about caring for your healing wound before you go home. You may be given a date for a follow-up appointment.

Recovering from aortic aneurysm open surgery

It usually takes at least six weeks to make a full recovery from this operation, but this varies between individuals, so it's important to follow your surgeon's advice. You may be off work for about six to 12 six weeks.

You will probably feel tired for several weeks after the operation, but this will gradually improve.

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

What are the risks?

As with every procedure, there are some risks associated with aortic aneurysm open surgery. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.


Side-effects are the unwanted but mostly temporary effects you may get after having the procedure.

After open surgery for an aortic aneurysm, your healing wound will feel sore and it may leak fluid. This usually clears after a few days.


Complications are when problems occur during or after the operation.

The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in your leg (deep vein thrombosis, DVT).

Specific complications of open surgery for aortic aneurysm can include:

  • stroke
  • kidney failure
  • heart attack
  • a wound infection – you may need treatment with antibiotics if your wound becomes infected
  • infection of the graft – this is very rare, but serious, and usually means that your graft will have to be removed
  • erectile dysfunction – this can affect some men if nerves in the abdomen are damaged during the operation
  • spinal cord injury – this can leave you paralysed

Is surgery the only option if I have an aneurysm?


Surgery is usually only recommended if your aneurysm is at risk of bursting. If the risk of this happening is low, your surgeon will carefully monitor your condition and may suggest you make some lifestyle changes.


Because the operation itself carries some serious risks, or even death, surgery is usually only recommended if your aneurysm is at risk of bursting or if you have symptoms. If your aneurysm in less than 5.5cm in diameter, it's unlikely to burst.

Your surgeon will probably suggest you have regular ultrasound checks to see if the aneurysm grows over time. Surgeons call this 'watchful waiting' or surveillance.

He or she may also suggest some other measures that you can try to stop your aneurysm from getting bigger or from bursting. These might include stopping smoking and taking medicines to control your blood pressure and cholesterol. These measures can prevent the build-up of fatty deposits in your arteries, which is often associated with aneurysms.

Can I opt to have endovascular repair instead of aortic aneurysm open surgery?


Your surgeon will advise you on whether open surgery or endovascular aneurysm repair (EVAR) will be better for you. EVAR isn't suitable for everybody.


For some people, EVAR isn't possible, due to the location or shape of their aneurysm or the size of the arteries in their groin. Even for those people who are suitable for the procedure, open surgery is still often considered to be the better option – especially for those who are young and otherwise fit. This is because there is a need for life-long follow-up after EVAR and a risk of needing further treatment, which outweighs the small benefit of having this type of procedure for many people. Ask your surgeon for more information.

Will I be able to drive after my aortic aneurysm open surgery?


You will be able to drive only when you have fully recovered from your surgery.


You will need to notify the Driving and Vehicle Licensing Agency (DVLA) if you're diagnosed as having an aneurysm with a diameter of 5.5cm or more. However, you will be allowed to continue driving as long as your aneurysm isn't more than 6.5cm in diameter, and you either have a satisfactory medical test or you have surgery to repair the aneurysm.

You shouldn't drive after surgery until you're able to perform an emergency stop safely. This may take a few weeks. You should check with your surgeon if you aren't sure.