Introduction
The aorta is the largest artery in the body. It carries blood from the heart to the rest of the body. An aneurysm is a part of the aorta whose wall has become weak and has widened, like a bulge in a tyre.
If an aneurysm keeps growing, it may tear (dissection) or burst (rupture), which can be life-threatening. Surgery replaces the weakened part of the aorta with a strong tube graft so that blood flows safely.
Why the procedure is needed
Many aneurysms cause no symptoms for years and are found on a scan done for another reason. When symptoms occur, they may include:
- Chest, back or abdominal pain, particularly if it is sudden or severe (this needs emergency care)
- Breathlessness, cough or hoarseness if the aneurysm presses on nearby structures
- Leakage of the aortic valve when the aneurysm involves the part of the aorta next to the heart
- Tearing of the aortic wall (dissection) or rupture, which are medical emergencies
Who may benefit
- People whose aneurysm has reached a size, or is growing at a rate, at which the risk of tearing is judged to be higher than the risk of surgery
- People with symptoms such as new chest or back pain related to the aneurysm
- People with conditions that weaken the aorta (for example, Marfan syndrome, bicuspid aortic valve or a family history of aortic disease), who may need earlier treatment
- Patients with an aortic dissection or rupture, who need urgent or emergency surgery
- Smaller aneurysms are usually watched with regular scans and blood pressure control rather than operated on
Types of repair
The operation depends on which part of the aorta is affected and on whether the aortic valve is also diseased.
- Ascending aorta replacement
- The widened part of the aorta close to the heart is replaced with a tube graft. If the aortic valve is also diseased, the valve may be replaced or repaired at the same time.
- Aortic arch repair
- The curved part that gives off the vessels to the head and arms. It is more complex and may need special techniques to protect the brain during surgery.
- Descending and thoracoabdominal repair
- Aneurysms lower in the chest and abdomen. Some can be treated with a stent graft placed through the groin (endovascular repair) instead of open surgery.
- Open surgery vs stent graft
- Open repair replaces the weak segment directly; stent grafts are placed through blood vessels and suit selected anatomies. Your team decides which is suitable.
- Surveillance
- Small aneurysms are monitored with CT or MRI scans, and with blood pressure control, at intervals your doctor advises.
Procedure overview
Step 1: Assessment
CT or MRI scans show the size and position of the aneurysm. Echocardiography checks the aortic valve and heart. You discuss the plan with a cardiothoracic surgeon.
Step 2: Anaesthesia
General anaesthesia is used, with careful monitoring of blood pressure, the brain and other organs.
Step 3: Surgical access
The chest is usually opened through the breastbone for the part of the aorta near the heart, or through the side of the chest for the descending aorta.
Step 4: Circulation support
The heart-lung machine takes over circulation. For arch surgery, special methods may be used to protect the brain while the circulation is briefly slowed or paused.
Step 5: Replacing the weak segment
The widened section is removed or opened and replaced with a tube graft that is stitched to the healthy aorta. Valve and coronary artery work is done if needed.
Step 6: Monitoring and follow-up
Intensive-care monitoring follows. Lifelong follow-up with scans and blood pressure control helps check the rest of the aorta.
Clinical advantages
- Can lower the risk of dissection or rupture of a dangerous aneurysm
- Replaces the weak section with a durable graft
- May also treat a leaking aortic valve during the same operation
- With regular follow-up, many patients return to a good quality of life
Risks and considerations
Every operation carries risk. The points below are general; your own risk depends on your health and on the operation you need.
- Bleeding, infection and the general risks of open-heart surgery
- Stroke, spinal cord injury or kidney, lung or gut problems — more likely with more complex repairs and in emergencies
- Irregular heartbeat and need for temporary or permanent pacing in some patients
- Problems with the graft or the area where it joins the aorta, which are checked by follow-up scans
- Other parts of the aorta can still enlarge later, so scans continue lifelong
- Risk depends on the type of repair, urgency, age and other medical conditions
Frequently asked questions
Does every aneurysm need an operation?
No. Small aneurysms are usually watched with regular scans and blood pressure control. Surgery is considered when the aneurysm reaches a certain size, grows quickly or causes symptoms.
What are the warning signs of an emergency?
Sudden severe chest, back or abdominal pain, fainting or collapse. Call emergency services (1122) or go to the nearest hospital immediately.
Is a stent graft better than open surgery?
It depends on the part of the aorta and your anatomy. Stent grafts avoid a large incision but are not suitable for every aneurysm. Your team will advise.
Will I need follow-up scans?
Yes. Lifelong scans check the graft and the rest of the aorta. Controlling blood pressure and not smoking are also very important.
How long is the recovery?
Hospital stay is often one to two weeks and full recovery commonly takes a few months, but this depends on the operation and the patient.
Patient-friendly summary
Aortic aneurysm repair replaces a weakened, widened part of the main artery with a strong graft to lower the risk of tearing or bursting. Many aneurysms are only watched at first; surgery is advised when the risk of leaving them is higher than the risk of operating. Regular scans, blood pressure control and specialist advice are essential.