Open repair of abdominal aortic aneurysm (Open surgical repair of abdominal aortic aneurysm)
A major operation to repair a swollen, weakened section of the main artery in the tummy by sewing in a synthetic graft, to reduce the risk of it bursting.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- Open repair replaces a weakened, swelling section of the body's main artery with a synthetic graft to prevent it bursting.
- It is major surgery with serious risks, including a real risk to life, but it greatly reduces the much higher risk of a ruptured aneurysm.
- Repair is usually considered around 5.5 cm, or if the aneurysm grows quickly or causes symptoms; smaller aneurysms are monitored.
- The graft is durable and usually needs little long-term monitoring; recovery typically takes 2–3 months.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your surgeon will give you advice for your situation.
Greatly reduces the risk of the aneurysm bursting, which is often fatal
The aneurysm is small (below about 5.5 cm) and not growing fast or causing symptoms, so monitoring is safer than operating.
You are monitored closely, often in intensive or high-dependency care at first, with pain relief, drips and a catheter. You are gradually helped to drink...
Care in a specialist vascular unit with appropriate intensive/high-dependency support.
You are monitored closely, often in intensive or high-dependency care at first, with pain relief, drips and a...
Tubes and drains come out as you improve, you start walking on the ward, and bowel function returns. You go home...
Energy slowly returns. You build up walking, avoid heavy lifting and driving until advised, and the wound...
Most people return to normal activities and, where relevant, work over this period. Full recovery of strength and...
What is open repair of an abdominal aortic aneurysm?
The aorta is the main artery carrying blood from the heart down through the body. An abdominal aortic aneurysm (AAA) is a swollen, weakened section of the aorta in the tummy. As it grows, the wall becomes thinner and there is a risk it can burst (rupture), which is often fatal.
Open repair is a major operation to fix the aneurysm before it bursts. The surgeon makes a cut in the tummy (or sometimes the side), clamps the aorta above and below the aneurysm, and sews in a synthetic tube (a graft) to replace the weakened section. Blood then flows through the strong graft instead of the ballooned wall.
Most aneurysms cause no symptoms and are found through the NHS screening programme (which invites men at 65) or by chance on a scan. Repair is generally considered when an aneurysm reaches about 5.5 cm across, is growing quickly, or causes symptoms — because below that size, for most people, the risk of surgery outweighs the risk of rupture.
Open repair is a bigger operation than the keyhole alternative (EVAR), with a longer recovery and higher early risk, but the repair is durable and usually needs less long-term monitoring. UK guidance (NICE) recommends open repair as the usual choice for most people with a standard (infrarenal) aneurysm who are fit enough, with EVAR considered when open surgery is too risky or unsuitable.
Types & techniques
There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.
Open repair vs EVAR (keyhole)
| Feature | Open repair | EVAR (keyhole) |
|---|---|---|
| Approach | Tummy incision | Through groin arteries |
| Early risk | Higher | Lower early on |
| Recovery | 2–3 months | Often quicker |
| Long-term checks | Usually fewer | Lifelong scans |
| Durability | Very durable | More reinterventions |
NICE recommends open repair for most fit people with a standard aneurysm, and EVAR when open surgery is too risky or unsuitable. The right choice depends on your anatomy, age and fitness.
Preparing for your surgery
- Expect detailed pre-operative tests: CT scan of the aorta, heart and lung checks, blood tests and an anaesthetic assessment, as fitness for surgery is carefully weighed.
- Stop smoking as early as possible — it strongly affects healing, heart and lung risk, and aneurysm disease.
- Discuss all medicines; blood thinners and some heart, diabetes and blood-pressure medicines need a clear plan.
- Optimise heart, lung, blood pressure and diabetes control beforehand with your team.
- Arrange significant time off and help at home, as recovery takes weeks to months.
- Ask about prehabilitation (exercise, nutrition) to improve your fitness before surgery if there is time.
- Make sure you understand the risks, the alternative of EVAR, and what happens if you choose not to have surgery.
What happens
Open repair is done under general anaesthetic, often with an epidural to help with pain afterwards. You will usually have a urinary catheter and drips, and may be looked after in intensive care or a high-dependency unit straight after surgery.
The surgeon makes a cut in the tummy (or side), gently moves the bowel aside, and exposes the aorta. Clamps are placed above and below the aneurysm to stop blood flow through that section. The weakened wall is opened and a synthetic graft is sewn in to replace it; the old aneurysm wall is then often wrapped around the graft. The clamps are released and blood flows through the new graft.
The operation usually takes a few hours. Afterwards you are monitored closely, pain is managed, and you are gradually helped to eat, drink and get moving over the following days. Most people stay in hospital for around a week or more, depending on recovery and any complications.
Is this operation right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- The aneurysm is small (below about 5.5 cm) and not growing fast or causing symptoms, so monitoring is safer than operating.
- You are too frail or have heart, lung or kidney disease severe enough that surgery risk outweighs the benefit.
- EVAR is clearly more appropriate for your anatomy and fitness.
- You do not wish to accept the risks after a full discussion of the alternatives.
- Another serious illness means surgery would not improve your overall outlook.
Delay surgery if…
- You have an active infection or are acutely unwell from another cause.
- Your heart, lung or kidney problems can be improved first to lower surgical risk.
- Blood thinners or other medicines need adjustment and a clear plan.
- Important pre-operative tests (such as CT or cardiac assessment) are not yet complete.
- You need more time to understand the options and reach an informed decision (this does not apply to a ruptured or symptomatic aneurysm, which is an emergency).
Alternatives to discuss
- EVAR (keyhole repair) where the anatomy and fitness suit it.
- Continued ultrasound or CT surveillance for aneurysms below the repair threshold.
- Best medical therapy and risk-factor control (stopping smoking, blood pressure, cholesterol) alongside or instead of surgery in selected people.
- Conservative (non-surgical) management if a person is too frail to benefit from repair, focusing on comfort and risk-factor control.
- A second specialist opinion where the decision is finely balanced.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Anaesthetic choices
The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.
Benefits
- Greatly reduces the risk of the aneurysm bursting, which is often fatal
- Provides a durable repair that usually lasts for life
- Usually needs less long-term scanning and monitoring than keyhole repair
- Lower chance of needing further procedures on the aorta later than with EVAR
- Suitable for aneurysm shapes and anatomy that keyhole repair cannot safely treat
Risks & complications
- Pain, tiredness and a long recovery over weeks to months
- A large abdominal scar and temporary changes in bowel function (such as constipation or slow return of appetite)
- Temporary need for intensive or high-dependency care after surgery
- Reduced energy and strength for several weeks
- Chest infection or breathing problems after surgery
- Wound infection or a hernia (bulge) at the scar later
- Bleeding needing transfusion or a return to theatre
- Heart strain, irregular heartbeat or heart attack
- Kidney injury, sometimes needing temporary dialysis
- Death — open repair carries a small but real risk to life, higher in emergencies and in less fit people
- Reduced blood supply to the bowel (bowel ischaemia), which can be serious
- Reduced blood supply to the legs, or, rarely, the spinal cord (risk to leg or, very rarely, mobility)
- Sexual dysfunction from nearby nerves being affected
- Graft infection or, much later, problems at the graft
This is major surgery on the body's main artery, and the most serious risk is to life — small for a planned operation in a reasonably fit person, but much higher if the aneurysm has already burst or if you have significant heart, lung or kidney disease. Other serious risks include heart, kidney, bowel and breathing complications. These risks are weighed against the danger of leaving a large aneurysm untreated, where rupture is frequently fatal. Ask your surgeon for your personal estimated risk, which depends on your fitness and the aneurysm.
Published figures to discuss
Risk depends heavily on whether the operation is planned or an emergency, your age and fitness, and the aneurysm. Figures below come from trials and large UK series and should be read as ranges, not promises. Emergency repair of a ruptured aneurysm carries a far higher risk than planned surgery. Your surgeon can give a personalised estimate using your scans and health.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Death within 30 days (planned/elective open repair) | Roughly 2–5% in trials and UK series (about 4.7% in the open arm of the EVAR-1 trial; lower in some recent high-volume series) | Higher in less fit people; planned surgery is far safer than emergency repair. | Open repair for AAA: outcomes from a UK high-volume centre — PMCncbi.nlm.nih.govPublished figure |
| Death within 30 days (emergency repair of a ruptured aneurysm) | Much higher — broadly around 30% or more among those who reach surgery | Underlines why planned repair of a large aneurysm is offered before it bursts. | Open repair for AAA: outcomes from a UK high-volume centre — PMCncbi.nlm.nih.govPublished figure |
| Serious complication (heart, lung, kidney, bleeding, bowel) | A meaningful minority of patients; major complications are commonly treated as several percent or higher in consent discussions | Includes heart attack, chest infection, kidney injury, bleeding and, less often, bowel ischaemia; the exact figure depends heavily on fitness. | Open repair for AAA: outcomes from a UK high-volume centre — PMCncbi.nlm.nih.govSource-linked context |
| Need for further aortic procedures later | Lower than after EVAR; in EVAR-1, survival free from secondary intervention at 15 years was about 80% after open repair vs about 65% after EVAR | Late open-graft problems are uncommon but not impossible; this durability is one reason open repair is favoured for many fitter patients. | Open repair for AAA: outcomes from a UK high-volume centre — PMCncbi.nlm.nih.govPublished figure |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
Recovery — what to expect, and when
Recovery from open repair is substantial. Most people are in hospital for around a week or more, sometimes with time in intensive or high-dependency care, and it typically takes 2–3 months to feel back to normal.
- Marked tiredness and reduced stamina for several weeks
- Soreness and numbness around the wound, and a visible scar
- Reduced appetite and slow return of normal bowel habit early on
- Needing help with everyday tasks for the first weeks
- Gradual, week-by-week improvement rather than a quick bounce-back
Aftercare
- Build up gentle walking as advised and avoid heavy lifting or straining in the early weeks.
- Follow advice on when you can drive again (often several weeks) and check with your insurer.
- Take pain relief as prescribed and look after the wound as instructed.
- Eat well and stay hydrated to help healing and bowel function.
- Take medicines to protect your heart and arteries (such as blood-pressure and cholesterol treatment) as prescribed.
- Stop smoking and keep blood pressure and cholesterol controlled to protect the rest of your arteries.
- Attend follow-up appointments and know who to contact about wound, tummy or chest problems.
- Pre-operative heart, lung and CT assessments completed
- Smoking stopped or cut down as much as possible
- Significant time off work and help at home arranged
- Plan for medicines, including blood thinners, agreed
- Transport home and support for the first weeks organised
- Understanding of EVAR alternative and risks of not operating
- Surgical team and out-of-hours contact details saved
Scars and how they heal
Open repair usually leaves a long scar down the middle of the tummy, or along the side, which is firm and numb around it at first and fades over many months to a paler line. A bulge (incisional hernia) can develop at the scar over time and sometimes needs separate repair.
⚠ Get urgent help if…
- Sudden severe tummy or back pain, feeling faint or collapsing — call 999, this is an emergency
- Chest pain, severe breathlessness or palpitations — call 999
- A wound that is increasingly red, swollen, leaking or very painful, or a fever (signs of infection)
- Severe tummy pain, no bowel movements, vomiting or a swollen tummy
- A cold, pale or painful leg or foot
- Black or bloody stools, or new severe diarrhoea after surgery
Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your surgeon gives you.
Results & realistic expectations
A good result means the aneurysm is repaired, the danger of rupture is greatly reduced, and the graft works well for the long term. Because open repair is durable, most people need relatively little monitoring of the graft afterwards, though follow-up varies by unit.
Repair removes the risk from that aneurysm but does not cure the underlying artery disease. The rest of your arteries can still be affected, so controlling blood pressure, cholesterol and smoking, and taking protective medicines, remain important for your heart and overall health. Surgery does not undo damage already done elsewhere in the arteries.
An open repair graft is very durable and usually lasts for life, with late graft problems being uncommon. This durability, and generally lighter long-term monitoring, are key advantages over keyhole repair. The wider artery disease continues, however, so lifelong attention to risk factors and medicines matters for protecting your heart and other arteries.
Combining with other procedures
Before and around surgery, your team will assess and manage your heart, lungs, kidneys and other arteries, because aneurysm disease often goes with disease elsewhere. Stopping smoking and treating blood pressure and cholesterol are part of the overall plan, not optional extras. If you have another aortic or arterial problem, the order and combination of treatments will be planned individually.
Follow-up & long-term care
You will be reviewed after surgery to check the wound and your recovery. Long-term graft surveillance after open repair is usually less intensive than after EVAR, but you will have ongoing care for your arteries and risk factors, often shared with your GP. Report any severe tummy or back pain, wound problems or chest symptoms urgently.
- Take heart- and artery-protecting medicines (such as blood-pressure and cholesterol treatment) as prescribed
- Stop smoking and keep blood pressure and cholesterol controlled
- Attend any agreed follow-up or surveillance appointments
- Stay active and keep to a healthy weight within your team's advice
- Seek urgent help for sudden severe tummy or back pain at any time
Revision and secondary surgery reality
- Late problems with an open graft are uncommon, so reoperation on the aorta is less likely than after EVAR.
- An incisional hernia at the wound can develop and may need separate repair.
- Some people need treatment for complications such as wound infection or bowel issues in the early period.
- The rest of the arterial system can still develop disease, needing ongoing care rather than re-repair.
Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.
What good aftercare looks like
- Care in a specialist vascular unit with appropriate intensive/high-dependency support.
- A clear recovery plan covering pain relief, mobilising, driving and return to activity.
- Ongoing management of artery risk factors (smoking, blood pressure, cholesterol) and protective medicines.
- A named contact and urgent route for wound, tummy, leg or chest problems.
- Appropriate follow-up, including graft surveillance where indicated, shared with the GP.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- The complexity of the aneurysm and the graft required
- The need for intensive or high-dependency care after surgery
- Length of hospital stay and any complications
- Pre-operative tests (CT, heart and lung assessment) and the anaesthetic
- The surgical team and hospital facility fees
- Follow-up care and management of artery risk factors
- The surgeon's and anaesthetist's fees and the hospital facility fee
- Intensive/high-dependency care costs and expected length of stay
- Pre-operative scans and assessments
- What is covered if a complication or longer stay occurs
- Follow-up appointments and any graft surveillance
- Cancellation policy and what happens if surgery is postponed for fitness reasons
On the NHS? Open AAA repair is provided on the NHS when national size, growth or symptom criteria are met, and most aneurysms are detected through NHS screening or scans; this is specialist major surgery rather than a typical self-pay procedure.
You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Not being given a personalised risk estimate based on your fitness and the aneurysm.
- No clear comparison with EVAR and with continued monitoring.
- Underplaying the risk to life and of major complications.
- Not discussing the option of conservative management for a very frail person.
- No clear plan for heart, lung and kidney optimisation before surgery.
Marketing red flags
- Any suggestion that major aortic surgery is routine or low-risk.
- Pushing a particular approach (open or EVAR) without weighing your anatomy and fitness.
- Quoting only the best-case outcomes and not emergency or frail-patient risks.
- Pressure to decide quickly when the aneurysm is stable and not an emergency.
- No mention of national screening, surveillance thresholds or specialist MDT input.
Choosing a surgeon safely
- Check your surgeon is on the GMC Specialist Register for this area.
- Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
- You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
- Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good surgeon will welcome every one of these.
- What is my aneurysm's size and how fast is it growing?
- What is my personal estimated risk from open surgery, given my heart, lungs and kidneys?
- Am I suitable for EVAR instead, and what are the trade-offs for me?
- What does recovery realistically look like for someone of my age and fitness?
- What are the risks if I choose not to have surgery or to keep monitoring?
- How will my heart, lungs and other arteries be assessed and protected around surgery?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the surgeon who carries out my operation, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this operation not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Is open aneurysm repair done on the NHS?
When is surgery recommended rather than monitoring?
Should I have open repair or keyhole (EVAR)?
How dangerous is the operation?
How long is the recovery?
What happens if I decide not to have surgery?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS — Abdominal aortic aneurysm NICE NG156 — Abdominal aortic aneurysm: diagnosis and management Circulation Foundation (Vascular Society) — Abdominal aortic aneurysm EVAR trial 1 — EVAR vs open repair, 30-day mortality (PubMed) Open repair for AAA: outcomes from a UK high-volume centre — PMC EVAR trial 1 — 15-year follow-up (PubMed) NHS — Abdominal aortic aneurysm screening
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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