You may need open vascular reconstruction surgery if you have a damaged or blocked blood vessel. It can be performed as an elective or emergency surgery.

Open vascular reconstruction involves using a graft to restore blood flow through one of your blood vessels.

“Open” means the procedure is performed through a large incision. Endovascular procedures are performed with a thin tube inserted inside your bloodstream.

Read on to learn more about open vascular reconstruction, including how and why it’s performed.

Is open vascular reconstruction a major surgery?

Yes, open vascular reconstruction is a major surgery. It’s typically done with general anesthesia, so you’ll be asleep during the procedure. It may be performed as an emergency surgery or as an elective surgery to avoid serious complications in the future.

The purpose of open vascular reconstruction is to repair a blood vessel that’s:

  • damaged
  • bulging and weak (aneurysm)
  • blocked

The most common cause of a blocked blood vessel is atherosclerosis, or the buildup of plaque inside your blood vessels. It’s the underlying cause of death in about half of people in Western countries.

Other causes of blockages include:

Vascular reconstruction may also be required as part of a more complicated surgery. For example, it’s used together with a pancreatoduodenectomy to treat some people with pancreatic cancer.

Open vascular reconstruction can lead to serious complications or death during or after the procedure. The chances of developing complications depend on many factors, like which part of your body is being treated and your overall health.

Potential complications include:

  • chest infections, especially in people who smoke
  • blood clots
  • serious bleeding
  • wound infection
  • graft infection
  • fluid leaking from your wound
  • erectile problems
  • loss of blood supply to your limbs or organs
  • rupture of aneurysm
  • heart attack or other cardiac complications
  • kidney failure
  • death due to the condition being treated or other complications

Open vascular reconstruction can be lifesaving as an emergency surgery.

As an elective procedure, it can prevent future major cardiovascular events, like:

The success rates of vascular reconstruction are high. For example, about 96% of people make a full recovery after receiving abdominal aortic reconstruction for an aneurysm.

Endovascular procedures are generally preferred over open reconstruction since they’re associated with lower complication rates.

In a 2019 study, researchers compared the long-term results of 881 people who received either endovascular repair or open repair of an abdominal aortic aneurysm.

Researchers found that:

  • About 68% of people in the endovascular repair group and 70% in the open surgery group died during the 14-year study period.
  • The overall survival seemed to be better during the first 4 years with endovascular repair.
  • Survival was higher in the open repair group between years 4 and 8.
  • Survival was higher again in the endovascular repair group after year 8.
  • The difference in survival rate in each of these periods did not reach statistical significance.

Researchers concluded that while the people who underwent these procedures were generally of advanced age and had other illnesses that contributed to a high mortality rate, those who underwent endovascular surgery had better results in the first few years following their surgery.

Here’s a look at what you can expect before, during, and after your procedure.

Before the procedure

You won’t be able to eat or drink anything other than water for at least 6 hours before your procedure.

Before the surgery, healthcare professionals administer anesthesia through a vein. They may also give you an epidural into your back to help with pain relief. Healthcare professionals also insert a catheter into your bladder and place a tube into your stomach through your nose.

During the procedure

Here’s an example of what to expect for surgery to repair an abdominal aortic aneurysm:

  1. Your surgeon makes a large incision across your abdomen and possibly another one or two in your groin.
  2. They access the weakened part of your aorta that has the aneurysm.
  3. The damaged part of your aorta is replaced with a graft made from a synthetic material or, rarely, from one of your other blood vessels.
  4. Your surgeon closes your wounds with stitches or metal clips.

After the procedure

After your procedure, you’ll be taken to a recovery room. You’ll likely be on a breathing machine after the surgery but will be taken off as soon as possible.

Healthcare professionals will give you fluids through an IV until your bowel starts functioning again. You may receive pain relievers through your epidural. You’ll likely need to stay in the hospital for at least 7 days.

If your surgery is elective, you and your surgical team will have a preassessment meeting to check your overall health. Your care team is likely to order CT scans and other tests to determine where your blockage or aneurysm is located.

It’s generally recommended to quit smoking before your procedure to lower your risk of developing a chest infection and improve your recovery. Quitting can be difficult, so it’s recommended to work with your care team. They can build a cessation plan that works for you.

You may feel tired or weak for many weeks after your procedure. It’s generally a good idea to avoid lifting heavy objects for about 6 weeks. You can start driving when you can perform an emergency stop without pain, usually after about 3–4 weeks.

You may be able to return to work after about 6–12 weeks depending on your job.

The cost of your procedure depends on many factors, like the extent of your procedure and your geographic location.

For example, the nonprofit FAIR Health estimates that 80% of procedures in Boston to repair an aorta with a graft are less than $9,060, with the cost of anesthesia potentially reaching another $3,141.

The nonprofit estimates that 80% of procedures in Montana City, Montana, are less than $5,699, with anesthesia adding up to another $2,742.

Many insurance providers including Medicare cover at least most of the cost if you need emergency surgery or if it’s deemed medically necessary. If your health insurance covers emergency care, you cannot be charged more than the in-network rate.

Learn more about what Medicare covers in emergency situations.

Open vascular reconstruction is a surgery to treat a blocked or damaged blood vessel. It usually involves using a synthetic material to repair the diseased or damaged vessel.

Open vascular reconstruction is a major procedure. Your surgical team can give you the best idea of how to prepare for your procedure and how you can minimize your risk of major complications.