Abdominal Aortic Aneurysm Open Repair

Open AAA repair may be chosen for younger healthier patients because of its durability or based on the shape of the aneurysm. Although early recovery usually takes longer than with an endovascular approach, the risk of long-term complications related to the aneurysm may be lower. 

Preparation for the Operation

Tests required before the operation include blood tests, chest X-ray, cardiac tests such as an echocardiogram and stress test, and a CT scan. You will need to go to the Pre-Surgery Clinic at Trillium West Toronto and meet with an anesthetist before the operation. Ideally you should attempt to complete all these tests so the anesthetist can review the results with you. You also need to have a checkup with your family physician prior to surgery. You should take your surgical package to all the appointments. 

What does the operation consist of?

An incision is made in the abdomen, usually from just below the breastbone to the pubis. A new artery made of a tube of very strong Dacron fabric is stitched in place inside the aneurysm. The aneurysm is opened to ensure no blood flow persists inside the aneurysm around the graft. An autotransfusion device is used to collect the blood in the aneurysm and give it back to you at the end of the operation. The incision is then closed with staples. Sometimes the 2 arteries, which run to your legs, have aneurysms as well or are narrowed. Then a new artery shaped like a pair of trousers is used. The bottoms of the trousers are stitched to the leg arteries. An incision in each groin is sometimes needed for this type of operation. The new arteries last for 20 years or more.

What happens after the operation?

After surgery you will be cared for in the intensive care unit for the first night. You will have an epidural catheter (a tube in your back), which will be used to administer pain medication for 2-3 days after surgery. You will also have a catheter in the bladder for 2-3 days. Initially you will be allowed to drink only clear liquids until normal bowel function returns, usually 2-3 days after surgery. Depending on how you progress, you may be discharged home in 5-7 days.

Recovery at home

At home you should try to resume walking and normal activities. You should avoid lifting more than 15 lbs. You may feel tired and not feel like eating for a month or more. Your energy level and appetite should return to normal by 3 months. You should shower daily and clean the incision with soap and water. Your staples will be removed 2 weeks after surgery by your surgeon or family physician. You may resume driving after 2 weeks and sexual relations after 4-6 weeks. You should be able to return to a light job after 12 weeks and a heavy job within 6 months.

Complications

The risk of major complications with surgery is between 2 and 5% depending on your overall health. This risk must be weighed against the risk of aneurysm rupture. Possible rare complications include death, severe bleeding, heart problems, breathing problems, problems with the circulation to the kidneys, the legs or the intestines, paralysis of the legs and sexual dysfunction. About one third of patients require blood transfusion. A bulge, or hernia, can develop in the incision years later and may rarely require surgical repair.