Abdominal Aortic Surgery

An abdominal aortic aneurysm (AAA) is a balloon-like bulge in a major blood vessel. It forms at a weak spot in the vessel wall and can be fatal if it ruptures. An abdominal aortic aneurysm can be repaired with endovascular repair or open surgery. Both methods involve placing an artificial graft inside the damaged artery. Each type of procedure has risks and benefits.

Endovascular Repair

Before Surgery: An IV line will be started to give you medications and fluids, and the skin where the catheter will be inserted may be shaved.

During Surgery: Two small incision are made in the groin. A catheter (thin, flexible tube) is threaded through an artery at each incision. A graft made of wire mesh and fabric is placed inside the abdominal aorta and guided to the aneurysm. This takes pressure off the weak artery wall.

After the Endovascular Procedure: When the procedure is complete, your surgeon may do some tests to check the graft. The incisions in your groin will then be closed. You can expect to stay in the hospital for 1 to 3 days. You will be closely monitored. Your IV and urinary catheter (tube to drain urine) may remain in place until shortly before you leave the hospital.

Recovery: Recovery can take a week or less, allowing for a quick return to normal activities. Imaging tests then track the condition of the graft over time. The procedure often has a short recovery. Close follow-up is needed even if you feel fine. Also, be aware that in some cases the size and shape of a person’s blood vessels rule out endovascular repair.

    Going Home: Your surgeon will most likely clear you to go home when you are alert, your pain is under control, and you are able to eat and digest food. Have an adult family member drive you home. Once home, take medications as directed. Be as active as you can. You will most likely feel back to normal within a few days.

    Follow-up Care: After endovascular repair, you will need follow-up tests often. Your first follow-up visit will be about 1 week after the procedure. At this time, imaging tests will be done to check the graft. In most cases, imaging tests are needed every 3 to 6 months for the first 2 years. After that, you will most likely have yearly tests. If there is a problem with the graft, further endovascular repair or open surgery may be needed to fix it.

    Following an endovascular procedure, call your doctor if you have:

    • Swelling or bleeding at the insertion site
    • Chest pain or trouble breathing
    • A temperature of 100F or higher
    • A change in the temperature or color of your feet or legs
    • Pain in the low back or stomach area

    Open Surgery

    With this method, a single large incision is made in the abdomen. The graft is then sewn into the artery above and below the aneurysm. Open surgery involves a longer recovery period than an endovascular repair. But for some people, open surgery may be the only way to repair the aorta. Open surgery has been used for many years, and it has a good long-term track record. It may be recommended for younger people to ensure that the graft lasts over time.

      Before Surgery: Remember, do not eat or drink after midnight before the surgery. At the hospital, an IV line will be inserted into your arm to provide fluids and medications. General anesthesia will be given to you to make you sleep and keep your muscles relaxed during surgery. You may also be given pain medication through a thin, soft tube inserted into the spine (an epidural). 

      During Surgery: Surgery begins with an incision in your abdomen. The surgeon gently moves aside the organs to reach the aorta. The aorta is clamped to stop blood flow. The surgeon then opens the aneurysm and clears any blood clot. The graft is sewn to the aorta above and below the aneurysm. Some of the aorta wall may be removed. This helps make a snug fit when the aorta is wrapped around the graft. The aorta is then sewn together helping to protect the graft. The incision site is closed.

      After Surgery: After surgery, you will be taken to an intensive care unit (ICU). Your blood pressure, pulse, and breathing will be checked. You will also be given pain medication as needed. If you were given an epidural, it may stay in place to help control pain. At first, you will have several tubes in place to help your body function. They will be removed when they are no longer needed. These may include: a catheter to drain urine and a tube that is passed through the nose to the stomach (nasogastric tube) 

      Recovery: You will most likely be cleared to go home when you are alert, your pain is controlled and you can eat and digest food. Have an adult family member or friend drive you home. Recovery from open surgery does not happen overnight. You may be recovered as soon as 4 weeks after you go home. Or it can take a few months. As you recover, try to be active. But be sensible: If what you are doing hurts, stop. If you are tired, rest.

      At Home: Follow your surgeon’s instructions on caring for yourself at home. Ask a family member or friend to help with shopping, cooking, and other chores. Your appetite and digestion may not be normal at first. If so, try soup and other liquids. You may be prescribed a mild laxative. You should also:

      • Shower instead of taking tub baths for the first week
      • Take medications exactly as prescribed
      • Do not drive until your surgeon says you can
      • Keep any follow-up appointments with your surgeon

      Your Long-Term Recovery: Even after you are back to your normal routine, you may have less energy than usual. This may last for 2 to 3 months, or even longer. As long as you do not overdo it, exercise can help you get back to your full strength. So be as active as you feel able to be. And discuss any ongoing concerns with your healthcare provider.

      Call your doctor if you have these symptoms, or any others that concern you:

      • A very red, very tender, or draining incision
      • Fever over 100F
      • Pain in  your legs, abdomen or back