- the size of the aneurysm—2 inches is considered large
- the growth rate—a quarter of an inch within a year is considered fast-growing
- location of the aneurysm —some aneurysms require more urgent repair
- your general health
- your age—surgery may be more dangerous in older adults
Sometimes, an AAA may burst like a balloon and result in life-threatening internal bleeding. Surgery to repair this condition is called an open abdominal aortic aneurysm repair or open AAA repair.
Ideally, an open AAA repair is used to fix an aneurysm before it ruptures. Surgery becomes critical if the bulge bursts and causes internal bleeding.
Although most people make a full recovery from abdominal aortic aneurysm repair, it is a risky procedure. Your doctor may take a watch-and-wait approach before committing to surgery. The risks of sudden rupture have to be balanced with the risks of an operation. Reasons for you and your doctor to consider surgery include:
Before the surgery begins, you will be put to sleep with a general anesthesia. During surgery, the surgeon will position you in one of two ways:
In one approach, you will lie flat on your back. The surgeon will make an incision from below your breastbone to below your navel. The surgeon may need to cut across your belly.
In the second approach, you will be positioned on your right side. The surgeon can then make a six-inch cut from the left side of your stomach to just below your navel.
Once the initial incision has been made, the surgeon will quickly identify the aorta. One clamp will be placed above the aneurysm and another will be placed below it. After blood flow has been stopped, the surgeon will slice open the bulge. The damaged area will be removed and a tube-like graft will be inserted in its place. This tube graft is often made from man-made (synthetic) material.
Once the graft is in place, the surgeon will remove the clamps and stitch up the incision.
After surgery, you will need to stay in the hospital for an average of six days. Initially, you’ll be in the intensive care unit. While there, your doctor and the hospital staff can monitor your condition closely. You will be given blood-thinning medicines and pain relievers as needed.
As you begin to recover, you’ll be encouraged to slowly resume physical activity. Sitting up in bed and walking around are excellent ways to start rehabilitation. Once you’ve been given permission to go home, it will take up to three months of recuperation before you can resume normal activities.