Open Repair

Abdominal Aortic Aneurysm – Open Repair

When an aortic aneurysm reaches a dangerous size, it may need repair with open surgery. Not all patients are suitable for minimally invasive procedures which I would be happy to discuss with you.

Open aneurysm repair has been refined over many years, but it is still a large operation. For this reason, extensive medical testing and workup will be ordered prior to the operation, and a medical physician review is common. Routine blood tests will be required, including blood group testing.

The operation is performed under general anaesthetic with extensive intra-operative monitoring to ensure maximum safety. These may include an arterial pressure monitor in the artery at the wrist, a central line venous catheter and a urinary catheter. These are placed after anaesthetic for maximum comfort.

The operation is usually performed through an ‘up and down’ midline vertical incision in the abdomen, starting close to the rib cage and extending 2/3 of the length of the tummy. The abdomen is entered carefully and the opportunity is taken to carefully inspect everything to ensure no other serious abnormality is present. The intestines are gently retracted under packs to one side and this exposes the abdominal aorta and the aneurysm. The clamp sites are carefully dissected, and then a blood thinner given and circulated prior to the application of the clamps.

The aneurysm is opened and any ‘back bleeding’ vessels controlled. The aim of the operation is NOT to remove the aorta, rather to replace the aneurismal segment with an artificial aorta made of Dacron sewn to the normal aorta at the top and bottom. This excludes the aneurysm from the blood pressure and renders it safe. The clamps are released and the suture lines checked to ensure they are free from bleeding. The redundant aneurismal sac is then wrapped around the Dacron graft to protect it. The abdomen is carefully closed in layers.

It is usually for you to go to intensive care after an open aneurysm repair to ensure no complications develop. This is usually for several days, over which period the monitoring lines are progressively removed.

There are several complications which can occur during and after aneurysm repair including bleeding, bowel dysfunction, limb dysfunction, renal dysfunction, heart strain and heart attack, lung problems including pneumonia and others. In worst cases, death can occur, though 95% patients survive.

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