Aneurysm Surgery: Traditional Open Surgery

What is aneurysm surgery?

Aneurysm surgery, also called traditional open surgery, is a treatment for aortic aneurysms. An aortic aneurysm damages your aorta and causes life-threatening complications. The main purpose of open surgery is to prevent an aneurysm rupture or dissection. It can also repair damage after such an event happens.

A surgeon removes the damaged part of your aorta and replaces it with a synthetic fabric tube. This tube is called a graft. It functions as a new lining for your artery so blood can safely pass through.

A thoracic or vascular surgeon performs this procedure in a hospital surgical suite. This procedure is considered major surgery. Your surgeon needs to make a large incision in your chest or belly to access the aneurysm. The aneurysm might be located in your chest (thoracic aortic aneurysm) or a bit further down in your belly (abdominal aortic aneurysm).

Aneurysm surgery is often necessary to prevent serious complications or death. Like any major surgery, it carries risks. But the benefits usually outweigh the risks. Your provider will discuss your options with you and determine if you need surgery.

Who needs to have aneurysm surgery?

People who have a ruptured or dissected aortic aneurysm need this surgery. It’s an emergency surgery that can save your life. Other people might need this surgery if they have an aneurysm that’s at risk of rupturing but hasn’t yet. This risk increases if your aneurysm is getting bigger or causing symptoms.

People with a ruptured or dissected aneurysm

If your aneurysm ruptures or dissects, you need surgery right away. Call 911 if you have the following symptoms:

• Clammy, sweaty skin.
• Dizziness.
• Fainting.
• Fast heartbeat.
• Nausea and vomiting.
• Shortness of breath.
• Sudden, severe pain in your belly, lower back or legs.
• Sudden sharp and tearing pain in your chest or back.

People with an aneurysm at risk of rupturing

If you have an aneurysm, it’s important to visit your healthcare provider for checkups. An aneurysm that hasn’t ruptured or dissected can still be dangerous. So, your provider will keep an eye on the aneurysm and decide how best to treat it. You may need aneurysm surgery if you have:

• Pain in your belly, back, chest, groin or inner thigh.
• A pulsing sensation in your belly.
• Coughing, hoarseness or difficulty breathing.
• A larger aneurysm (at least 5 centimeters in diameter).
• Rapid aneurysm growth (growing more than 1 centimeter per year).

Your provider will talk with you about your condition and your treatment options. Your provider will check the aneurysm’s size, location and risk of rupturing. There’s a lot to consider, including your overall health and medical history. Your provider will tailor treatment to your individual needs.

For example, if you have Marfan syndrome, a smaller aneurysm will be more dangerous for you. So, you may need treatment sooner than someone who doesn’t have Marfan syndrome.

You might have other health problems that make open surgery too risky. If so, your provider may recommend endovascular aneurysm repair (EVAR). This is a less invasive aneurysm repair procedure.

What happens before aneurysm surgery?

Preparation for your surgery begins weeks in advance. Your provider will give you a physical exam and run some tests to make sure it’s safe to perform surgery. You’ll talk with your provider about:

• Medicines you’re taking. Your provider needs to know what drugs, supplements and herbs you’re using. Be sure to mention both prescription and over-the-counter medicines. You may need to stop taking some before your surgery. It’s important to closely follow your provider’s guidance on which drugs to take or avoid.
• Medical conditions. You’ll need to manage conditions like high blood pressure before your surgery.
• How you’re feeling. If you have a cold, flu, herpes breakout or any other illness, you need to tell your provider. Being sick could impact how you respond to surgery.
• Smoking. You should not smoke for at least one month leading up to your surgery. Your provider will give you resources to help you quit.

Your provider will give you specific instructions for how to prepare for the day of your surgery. These may include:

• Not drinking anything after midnight the night before your surgery. That includes water.
• Taking certain drugs the morning of your surgery.
• Finding someone to drive you home when you leave the hospital.

It’s important to follow all your provider’s instructions. Ask if anything is unclear or you have any questions.

What happens during aneurysm surgery?

Your care team will make you comfortable before your aneurysm surgery begins. You’ll be given general anesthesia so you’re asleep during the surgery. Then, your surgery will include the following steps:

1. Incision. Your surgeon will make a long incision in your skin to open your chest or belly. The location of the incision depends on the location of the aneurysm. It may be on the front or left side of your chest, and it may extend down to just below your belly button.
2. Clamping. Your surgeon will use clamps to block blood flow from the sections of your aorta above and below the aneurysm. You may be put on a heart-lung machine to keep your blood flowing to the rest of your body during the surgery.
3. Graft insertion. Inserting a graft is the main goal of the surgery. Your surgeon will replace the bulging section of your aorta with a tube called a graft. This graft now functions as a new lining for your artery. It’s made of an artificial material like polyester (fabric). It has strong walls to support your blood flow. Your surgeon will sew the graft in place with stitches.
4. Closure. Your surgeon will close the incision in your chest or belly with stitches or staples.

Aneurysm surgery usually takes three to four hours.

What happens after aneurysm surgery?

After your surgery is done, you’ll be moved to the intensive care unit (ICU). You’ll be closely watched for several days before being moved to a regular hospital room. Your total hospital stay will likely be three to 10 days.

While you’re in the hospital, you’ll receive care that includes:

• A urinary catheter to help you pee.
• A tube through your nose and stomach that drains fluids.
• Blood-thinning medication (anti-coagulants).
• Compression socks that help prevent blood clots in your legs.
• A breathing machine to help support your lungs.
• Pain medication to ease your recovery.

You’ll slowly begin moving around and regaining your strength. But remember that you just had major surgery. Your body needs time to heal. Closely follow your provider’s instructions, and don’t push yourself too soon. It’s important to give yourself time to rest.

Be sure to arrange for someone to drive you home from the hospital. You won’t be able to drive until your provider gives you the OK.

What are the advantages of aneurysm surgery?

Aneurysm surgery can save your life. It can prevent an aneurysm rupture or dissection. It can also be performed in an emergency to repair damage from an aneurysm rupture or dissection.

Open surgery is a good option for people who can’t have endovascular aneurysm repair (EVAR). For example, the stent graft used in EVAR doesn’t always fit the shape of a person’s aorta. So, that person would need open surgery.

What are the risks and complications of aneurysm surgery?

Aneurysm surgery can save your life. But it’s important to be aware of possible risks and complications. They include:

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

Talk with your provider about all possible risks. And ask which ones are more likely based on your own health condition. Risks and complications change based on the individual.

Surgery is never risk-free. But your care team will do everything possible to make your surgery safe and successful.

What are the chances of surviving aneurysm surgery?

Aneurysm surgery is very serious if performed after an aneurysm rupture. The chance of survival after surgery for a ruptured aortic aneurysm is 50% to 70%. The greatest threat comes from complications of the rupture, including kidney failure. But with no treatment at all, the rupture will certainly be deadly. So, surgery offers the best chance of survival after a rupture.

The chance of survival is much better when you have surgery before a rupture. In that case, the chance of surviving aneurysm surgery is 95% to 98%.

Open surgery is riskier for people with other serious health problems, including:

• Heart disease.
• Kidney failure.
• Lung disease.
• History of a stroke.

Older people also face a higher risk of complications. Your provider will discuss your individual risks with you.

Most people fully recover from aneurysm surgery, especially if the aneurysm didn’t rupture first.

How long does it take to recover from aneurysm surgery?

You’ll need three to 10 days to recover in the hospital. Some people need more time. After leaving the hospital, you may need to stay at a rehabilitation facility. This helps you regain your strength and independence. Full recovery takes four to six weeks for most people. But some people may need two or three months to get back to normal.

Restrictions during recovery

Your healthcare team will give you specific instructions to follow as you recover. Restrictions may include:

• No driving until your provider says it’s OK. This is usually at least one to two weeks after your surgery when you’ve stopped taking pain medication.
• No baths until your incision heals. You may take a shower or sponge bath, but be careful around your incision.
• No swimming until your incision heals.
• No heavy lifting (more than 10 pounds) for four to six weeks. This may be longer depending on how you’re healing. Follow your provider’s instructions.
• No heavy exercise or activities that make you out of breath.

Dealing with pain

You’ll have prescription pain medicine to take when you’re recovering at home. Write down what time you take each dose. And try to take the pills at the same time each day. This may help your medicine work most effectively.

Caring for your incision (surgical wound)

Your incision is the area on your chest or belly that was cut open for surgery. Now it’s all closed up, but it’s still a wound. It needs special care while you recover. Your provider will offer guidance on how to care for it. You’ll likely need to change the dressing (bandages) at least once per day. Don't remove the dressing to take a shower unless your provider says it’s OK.

Sneezing or coughing might feel uncomfortable for a while. To ease any pain, hug a pillow against your incision when you sneeze or cough. This can also protect your incision.

Changes in appetite and energy level

As you recover, you may notice you’re not as hungry as usual. This is normal. It may take a few weeks for your appetite to return. Some people lose up to 20 pounds during recovery.

You may also feel tired for a few weeks. This is part of healing. Talk with your provider about how you’re feeling and any concerns you have.

What can I do to prepare for my recovery at home?

Preparing for surgery can be nerve-wracking. Devote some of that nervous energy to making your home comfortable for your return. Ask family and friends to help you. Some tips include:

• Set up a bed and living space on the first floor. You’ll probably be able to use stairs. But it’s a good idea to limit any risks of falling as you heal.
• Stock up on food and personal supplies.
• Make meals ahead and freeze them.
• Store supplies in cupboards or spaces that don’t require bending down low or reaching up high.
• Have an easy-to-reach place for your phone and charger.

If you live alone, ask someone to stay with you or spend time with you each day. You may also want to arrange for someone to bring groceries or other supplies.

If you don’t have family or friends close by, ask your healthcare provider to recommend a caregiving service. It’s important to accept help from others as you heal. The more help you have now, the quicker you will recover and regain your independence.

What lifestyle changes should I make after aneurysm surgery?

Your surgery was a big investment in your health. But you have to protect that investment. Do whatever you can to support the health of your heart and your whole body, including:

• Eating a heart-healthy diet. Reduce your intake of salt, sugar and saturated fat. Drink plenty of water.
• Exercise. Ask your provider which exercises are best for you.
• If you smoke, it’s time to quit. Smoking damages your arteries and causes many other health problems. Work with your provider to get the resources and support you need.
• Manage conditions like high blood pressure, high cholesterol and diabetes. Take your medications, and talk with your provider about your numbers.
• Join a support group to meet other people who have been in your shoes. Support groups can help you stay on track with lifestyle changes. They can also be a great way to learn about new resources and treatments.

When should I see my healthcare provider?

As you recover from aneurysm surgery, pay attention to how you feel. Call your provider if you have any of these problems.

Incision (surgical wound) problems

• Redness, pain, warmth or swelling.
• Blood or clear fluid soaking through your bandage.
• Green or yellow drainage.
• Edges of your incision coming apart.

Other problems

• Severe or persistent pain in your back or belly.
• Swollen legs, or inability to move your legs.
• Chest pain or shortness of breath even when you rest.
• Dizziness, fainting or extreme fatigue.
• Coughing up blood, or coughing up yellow or green mucus.
• Chills or fever.
• Blood in your bowel movements.

A note from Cleveland Clinic

Aneurysm surgery is a life-saving procedure that can help your arteries get healthy. For some people, it’s an emergency surgery in response to a ruptured aneurysm. For others, it’s a preventive measure planned months in advance. But either way, it’s a major surgery that has its own risks. Talk with your provider about what treatment option is best for you. If you have an aneurysm or a history of aneurysms, go for regular checkups so your provider can keep an eye on things. It’s essential to treat an aneurysm before it grows too big or causes serious problems.