Open Repair of Aortic Aneurysm

Open repair of an Aortic Aneurysm still has an important role in the management of a minority of patients with aortic aneurysms (AAA). It is generally reserved for patients where the anatomical criteria for endoluminal repair are not met or occasionally is the preferred choice in relatively young patients

Pre-operative preparation

In order to prepare for this procedure, it is vital that a full medical assessment is completed to confirm fitness for anaesthesia.

This will involve a number of blood tests, an assessment of the heart with an ECG and thallium scan, and possible referral to a cardiologist if there are any concerns about your heart.

In addition, as part of your work-up, a CT scan of the abdomen has almost invariably been performed.

Day of procedure

You may be admitted on the morning of the procedure if your assessment has been completed. You will be required to bring ALL your usual medications.

It is important to fast for at least 6 hours prior to the procedure. For a morning procedure, you will need to fast from midnight, whereas for an afternoon procedure, this will mean fasting from 7am.

NOTE: If you have any concerns, phone Northwestern vascular immediately

Your anaesthetist will consult you prior to the operation and explain the anaesthetic and its risks to you.

The procedure

A full general anaesthetic is administered. A tube is inserted into your windpipe (trachea) to help with your breathing while you are asleep. A catheter is also inserted into your bladder to help in monitoring your urine output. This will remain in position for the first 48 hours.

The operation is performed through an abdominal incision, passing from the chest to the pubic bone.

Heparin is administered to help keep the blood thin. The aorta is clamped above and below the aneurysm. In nearly all cases, this occurs below the arteries to the kidneys, so there is no interruption in blood flow to the kidneys. Clot adherent to the wall of the aneurysm is removed, and back bleeding from arteries coming off the aneurysm is controlled.

In order to restore vascular continuity, a synthetic (Dacron) graft either as a tube or “trouser” is sewn into position. Clamps are released to restore circulation to both legs, usually sequentially and slowly, to allow maintenance of blood pressure. All vascular joins are checked, and any leaks sealed. The wound is then closed and dressing applied.

Post-operative course

All patients return to the intensive care unit for at least the first 24 hours for stabilisation, correction of any fluid imbalance and to ensure heart and lung function is optimised. Patients are then transferred to the ward, where oral fluids and diet is slowly re-introduced, and mobilisation commenced. It is a gradual process, but most patients are fit for discharge at about 7 to 10 days following the procedure.

The recovery takes up to 6 weeks, during which time I encourage a gradual increase in activity and mobility

If you require more information about aortic aneurysm, contact Northwestern Vascular