Abdominal aortic aneurysm surgery (open repair)

The aorta is the largest artery in the body. In the abdomen, its wall can weaken and gradually widen: this is an aneurysm. It usually causes no symptoms and is often discovered on an ultrasound or CT scan. The danger is rupture, a serious emergency, and the risk increases with the size of the aneurysm. In open surgery, the surgeon reaches the aorta through an incision in the abdomen or flank, temporarily stops the blood flow, opens the aneurysm and replaces it with a synthetic fabric tube (graft), straight or Y-shaped when the iliac arteries are also affected. The aneurysm wall is then closed around the graft to protect it. Surgery is offered when the aneurysm reaches a size at which the risk of rupture exceeds the risk of the operation (most often around 5 to 5.5 cm), when it grows quickly or when it causes pain. The open approach is chosen in particular when the shape of the aorta is not suitable for a stent graft, or in younger patients, because it gives a durable result with lighter follow-up. The endovascular alternative is always discussed. At Clinique Pasteur Tunis, this major operation is performed in the operating theatre, with post-operative monitoring in intensive care and then on the ward, by a team experienced in both open and endovascular approaches.