What is Open Aortic Surgery?
Open aortic surgery, also known as open aortic repair, is a traditional surgical technique employed in the treatment of aortic aneurysm.
Aortic aneurysm is a condition characterized by an abnormal ballooning or bulging of a section of the aorta due to weakness in the wall of the blood vessel. The aorta is the main blood vessel that carries oxygenated blood from the heart to the different parts of the body. An aneurysm can develop anywhere along the course of the aorta.
- Aneurysms that occur in the section of the aorta that passes through the abdomen is called an abdominal aortic aneurysm.
- Aneurysms that occur in the part of the aorta that passes through the chest is called a thoracic aortic aneurysm.
If left untreated, aortic aneurysms can grow too large and burst open, leading to a large amount of internal bleeding, resulting in often life-threatening complications.
Open aortic surgery involves making a large incision along the abdomen or chest to access the diseased portion of the aorta and repairing it in order to prevent the aneurysm from bursting.
Indications for Open Aortic Surgery
Your surgeon may recommend open aortic surgery under the following conditions:
- The aneurysm or bulge is increasing or growing in size (5 cm or more in diameter)
- There is a risk of rupture due to the large size of the aneurysm, which can cause death
- Damage to the aorta from injury or trauma
- To treat focal penetrating ulcers in the aorta
- To treat aortic stenosis or narrowing of the aorta
- To treat aortic dissection or separation of the 3 layers of the aorta
- Conservative measures have failed to relieve the symptoms of aortic aneurysm such as pain, bleeding, and high blood pressure
Preparation for Open Aortic Surgery
Preoperative preparation for open aortic surgery may involve the following steps:
- A review of your medical history and a physical examination to check for any medical issues that need to be addressed prior to surgery.
- Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could compromise the safety of the procedure.
- You will be asked if you have allergies to medications, anesthesia, or latex.
- You should inform your doctor of any medications or supplements you are taking or any conditions you have such as heart or lung disease.
- You may be asked to stop taking blood-thinners, anti-inflammatories, or other supplements for a week or two.
- You should refrain from alcohol and tobacco at least a few days prior to surgery and several weeks after.
- You should not consume any solids or liquids at least 8 hours prior to surgery.
- You may be asked to shower with an antibacterial soap prior to surgery to reduce the risk of infection.
- Arrange for someone to drive you home as you will not be alert enough to drive yourself after surgery.
- Informed consent will be obtained from you after the surgery has been explained in detail.
Procedure for Open Aortic Surgery
Open aortic surgery is usually performed under general anesthesia and involves the following steps:
- You will lie on your back on the operating table and the area of incision is shaved and cleaned with an antiseptic solution.
- A long surgical cut is made on the chest or the abdomen depending upon the area in which the aneurysm occurs.
- Clamps are placed on the aorta, above and below the aneurysm, to restrict the blood flow through the area that your surgeon is working on.
- If the aneurysm is found just above the heart, you will be connected to a cardiopulmonary bypass machine (heart-lung machine) to maintain blood circulation and keep you breathing during the surgery.
- Your surgeon will then remove the bulged and weakened section of the aorta and replace it with a synthetic tube or graft. For some aneurysms, the wall of the aneurysm is left intact, and the graft is placed within the aneurysm. The graft allows the blood to flow through the aorta without making it bulge.
- Finally, the clamps are removed so that the blood starts flowing through the aorta again.
- Your surgeon will then close the incision site with stitches or staples and a bandage is applied accordingly.
- The entire procedure can take about 3 to 4 hours.
Postoperative Care and Recovery
In general, postoperative care instructions and recovery after open aortic surgery will involve the following steps:
- You will be transferred to the recovery room where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs. You may need to stay in the hospital for at least a week.
- You may experience pain, inflammation, and discomfort in the operated area. Medications are prescribed as needed to manage these.
- You are encouraged to move on the bed and walk as frequently as possible to prevent the risk of blood clots.
- Antibiotics are also prescribed to address the risk of surgery-related infection.
- Application of ice packs to the operated area is also recommended once the bandage has been removed to reduce swelling and pain.
- Instructions on incision site care and bathing will be provided to keep the wound clean and dry.
- Refrain from strenuous activities, lifting heavy weights, and driving for at least 4 to 6 weeks after the procedure. A gradual increase in activities is recommended.
- You should be able to return to work and resume your normal daily activities in 6 weeks’ time, with certain activity restrictions.
- Periodic follow-up appointments will be scheduled to monitor your progress.
Risks and Complications
Open aortic surgery is a relatively safe surgery; however, as with any surgery, some risks and complications may occur, such as:
- Wound Infection
- Blood clots or deep vein thrombosis (DVT)
- Heart-related issues
- Urinary or respiratory infections
- Kidney damage
- Graft migration/infection