About Aortic Aneurysm Surgery

Aortic aneurysm is among the most common aneurysm problems. Aortic aneurysm repair is the most common aortic surgery we perform at OHSU.

If you need surgery for an aortic aneurysm, you probably have questions. Which type of surgery is best? Why does my Aortic Program doctor recommend a certain type of surgery?

The information below answers common questions patients have about aortic aneurysm surgery. 

What is an open aortic aneurysm repair?

Your doctor makes an incision (cut) in the skin and tissue while you are under anesthesia. The doctor operates directly on the aorta through the incision.

Your doctor puts two clamps on the aorta, above and below the aneurysm. This keeps blood from flowing through the surgery area. Then, the doctor sews a small device called a "graft" where the aneurysm is. The walls of the graft act like the walls of a healthy aorta, so blood can keep flowing through the whole aorta without the risk of bursting.

When the graft is in place, your doctor takes off the clamps. Then, he or she watches until blood is flowing well through the aorta again. After that, your doctor closes the incision. You go to the recovery room to wake up from surgery.

What is EVAR?

EVAR
Image credit: National Institutes of Health

Endovascular aneurysm repair is called "EVAR" for short. In open surgery, your doctor does the operation through one large incision (cut). In EVAR, your doctor treats the aneurysm through small incisions.

Your doctor puts a small, hollow tube called a "catheter" in one of your other blood vessels through a small incision (cut). A small medical device called a "graft" is put through the tube and moved up to the aneurysm. When the graft reaches the aneurysm, your doctor lets it expand. The walls of the graft act like the walls of a healthy aorta, so blood can keep flowing through the whole aorta without the risk of bursting. Doctors sometimes put more than one graft in the aneurysm.

Doctors use X-rays to show where to move the catheter inside your body. X-rays show images of what is happening inside the aorta during the procedure, so your doctor can always see the catheter and other instruments.

EVAR has no large incision (cut). This means it is easier on your body than open surgery, so recovery is usually much shorter. Also, patients usually have fewer problems in the days and weeks after EVAR than after open surgery.

Another advantage of EVAR is that you might not need general anesthesia. Your doctor can often do EVAR with local anesthetic. With local anesthetic, the area of the procedure is numb, so you do not feel pain or discomfort. You also get medication to help you relax.

The right aneurysm treatment for you depends on many factors. These include your general health, age, aneurysm and more. Talk with your OHSU Aortic Program doctor about both EVAR and open surgery. Ask the aortic surgeon what is the best option for you, and make sure you understand the answer. If you do not understand, one of our aortic team members will take the time to help you understand the options. We want to make sure you feel confident about your OHSU Aortic Program consultation.

What is TEVAR?

TVAR
Image credit: National Institutes of Health

Thoracic endovascular aneurysm repair is called "TEVAR" for short. TEVAR is a minimally invasive surgical technique used to fix an aortic aneurysm. It is done through small cuts (incisions) in your groin or lower abdomen.

During TEVAR, your surgeon will use X-rays (fluoroscopy) and special catheters to place an aortic stent graft (a flexible wire frame sewn on a specially woven fabric tube) inside of your aneurysm. This reduces pressure on your aneurysm and lowers the risk that it will rupture.

If you have TEVAR, you will likely spend about 2-4 days in the hospital, compared to at least a week for aneurysm repair done with open surgery.

Experienced aortic surgeons

Experienced aortic surgeons

The OHSU Aortic Program is fortunate to have some of the most experienced surgeons in Oregon and the United States at open aneurysm repair, EVAR and other aortic problems. Our goal is to offer you the very best aortic disease treatment available.

Read about the aortic disease specialists at OHSU Knight Cardiovascular Institute

After your aneurysm surgery

When you go home depends on the type of surgery you had, your health before and after surgery, and other factors. If you have EVAR, you might go home in one or two days. If you have open surgery, you will probably be ready to go home in five to seven days. Your doctor and Aortic Program team members will talk with you about how long you will probably stay in the hospital.

Before you leave the hospital, your doctor and Aortic Program team will talk with you and your family members about checkups and home care. This includes teaching you and your family members to do any care activities you need. You can come back to the Aortic Program clinic at OHSU Knight Cardiovascular Institute for your checkups. If you do not live near OHSU, you might be able to have checkups near your home.