Some aneurysms are best fixed with an open surgical approach. Open surgery involves identifying the aneurysm through an incision down the center of the abdomen. The intestines are shifted to the side, because the aorta sits in the back, on top of the spine. Blood flow is stopped through the aneurysm temporarily with clamps on the vessel above and below, and then the aneurysm is opened lengthwise. A Dacron tube graft is hand sewn into the normal artery above the aneurysm and the normal artery below it. The aneurysm wall is then closed over the top of the graft to protect it. The graft stays in forever and, over time, your body forms a lining inside it that looks like the normal artery.
This surgery is performed under a general anesthetic. Sometimes we supplement the anesthetic with an epidural, which can be used afterwards for pain control. The surgery takes two to three hours. Some people require a blood transfusion. After surgery, you are monitored initially in the Intensive Care Unit. You will have a tube in your nose to remove gastric juices, so that you don’t get nauseated. You will have monitoring lines for blood pressure and fluid management. The typical hospital stay is three to five days, depending on pain control and how long it takes your intestines to “wake up” and resume normal function following surgery. Open surgery is considered a more major procedure than EVAR because of the strain on your heart and lungs during surgery. Most often you will undergo preoperative testing to assess your risk for this type of surgery. Potential risks of surgery are the same as for EVAR and include: heart attack, arrhythmia (abnormal heart rhythm), prolonged intubation, pneumonia, kidney failure, infection, stroke, bleeding, or distal embolization.