Mr Bicknell explains that open surgery is one of the main treatment options for abdominal aortic aneurysms (AAA). He explains the steps of the procedure, which involves a large cut in the abdomen. When the aorta is exposed, it is clamped above and below the aneurysm. The aneurysm is then opened up and a fabric tube is sown in. It is a major operation which requires a short stay in high dependency or intensive care unit, around 7-10 days in hospital, and a few weeks or months to recover. The short-term complications are higher than the endovascular (keyhole approach). But the main advantage is that the repair is usually more long lasting.
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a certain proportion of patients need to have an open repair and they might have an open repair because they are younger and they need this repair to last throughout their life. They might have an open repair because it's their choice or they might have an open repair because the anatomy or configuration of the aneurysm is not suitable for a stent graft. In the open repair, the patient undergoing the repair is on general anaesthetic. There's a cut usually from top to bottom in the abdomen. The guts are moved to the right hand side and upwards and a dissection of the back of the abdomen is carried out to expose the aorta and the aneurysm and the iliac artery is below it. What we do is we thin the blood, put clamps on above and below the aneurysm, open up the aneurysm itself and then you can see the top and bottom and a fabric tube, usually made out of Dacron or Gortex, is sewn into place. Afterwards we let the clamps off, the blood flows down to the pelvis and the legs and if everything's okay you close the aneurysm, sack around, put the guts back in place, close up the patient. It's a big operation and it requires one or two days in a high dependency or intensive care situation to make sure you're not bleeding and to make sure that the pain is well controlled and the lungs are functioning and you're up and out of bed as soon as we can. But most people end up with their recovery spending somewhere between seven and ten days in hospital before returning home and it does take a while to get back to normal activity, sometimes three to six months. The mortality or the death rate associated with that operation is higher than that of the keyhole approach and the number of complications experienced which can include chest problems, kidney problems and heart problems is higher than that of the stent grafting approach. But the advantage is once that operation is done, most patients go through the rest of their lives without needing to go back into surgery. The repair is a long-lasting one. Although you can have degeneration elsewhere in the aorta, that area that's been fixed normally stays fixed and that's attractive to many people, especially in patients who are going to live for 10, 15, 20 years after their repair.
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