What are the different types of abdominal aortic aneurysm (AAA) surgery?

Dr. Mark J. Russo, MD
Cardiothoracic Surgeon

There are three approaches of repairing for abdominal aortic aneurysms (AAA): open surgery, endovascular (TEVAR), and the hybrid approach. The type of surgical repair of AAA will depend on several factors, including the location of the aneurysm, the type of aneurysm, and the patient's tolerance for the procedure. 

Open repair is the standard treatment. An incision is made in the midline of the abdomen or in the flank. These approaches allow the surgeon to visualize the aorta directly to repair the aneurysm. 

An alternative approach for a AAA repair is endovascular (EVAR) aneurysm repair. It is similar to the approach used for a cardiac catheterization of the coronary arteries. This procedure requires only small incisions in the groin. Then the surgeon inserts a catheter through the femoral artery in the groin and with the use of x-ray guidance and specially-designed instruments, the aneurysm can be repaired from inside the aorta by inserting a tube, called a stent-graft. This is possible because the tube, or stent graft, is delivered through the catheter in a collapsed state and then expanded at the site of the aneurysm. The tube replaces and reinforces the diseased aortic wall, ensuring continuity of blood flow while preventing further expansion of the aorta, aortic rupture, and/or aortic dissection.

However, not all aneurysms can be repaired by means of endovascular stenting alone. Therefore, a third option, called a hybrid procedure uses endovascular stenting along with open surgery to take advantage of the benefits of each while minimizing the limitations and related risks. Often, hybrid procedures can be custom designed for the patient in an effort to decrease size of the incision and duration of the procedure.

One type of aortic aneurysm treatment is an endovascular repair, performed by a cardiologist, in a cardiac catheterization lab. This procedure is less invasive and is done via a puncture in the inguinal area. These procedures are for treatments of known aneurysms. If an abdominal aortic aneurysm ruptures, it is a life-threatening emergency and must be addressed via an open surgical procedure.

An abdominal aortic aneurysm, also called AAA or triple A, is a bulging, weakened area in the wall of the aorta.

There are two approaches to abdominal aortic aneurysm (AAA) repair. The standard surgical procedure for AAA repair is called the open repair. A newer procedure is the endovascular aneurysm repair (EVAR).

  • Abdominal aortic aneurysm open repair: Open repair of an abdominal aortic aneurysm involves an incision of the abdomen to directly visualize the aortic aneurysm. The procedure is performed in an operating room under general anesthesia. The surgeon will make an incision in the abdomen either lengthwise from below the breastbone to just below the navel or across the abdomen and down the center. Once the abdomen is opened, the aneurysm will be repaired by the use of a long cylinder-like tube called a graft. Grafts are made of various materials, such as Dacron (textile polyester synthetic graft) or polytetrafluoroethylene (PTFE, a non-textile synthetic graft). The graft is sutured to the aorta connecting one end of the aorta at the site of the aneurysm to the other end of the aorta.
  • Endovascular aneurysm repair (EVAR): EVAR is a minimally invasive (without a large abdominal incision) procedure performed to repair an abdominal aortic aneurysm. EVAR may be performed in an operating room, radiology department, or a catheterization laboratory. The physician may use general anesthesia or regional anesthesia (epidural or spinal anesthesia). The physician will make a small incision in each groin to visualize the femoral arteries in each leg. With the use of special endovascular instruments, along with x-ray images for guidance, a stent-graft will be inserted through the femoral artery and advanced up into the aorta to the site of the aneurysm. A stent-graft is a long cylinder-like tube made of a thin metal framework (stent), while the graft portion is made of various materials such as Dacron or polytetrafluoroethylene (PTFE) and may cover the stent. The stent helps to hold the graft in place. The stent-graft is inserted into the aorta in a collapsed position and placed at the aneurysm site. Once in place, the stent-graft will be expanded (in a spring-like fashion), attaching to the wall of the aorta to support the wall of the aorta. The aneurysm will eventually shrink down onto the stent-graft.

The physician will determine which surgical intervention is most appropriate, either open repair or EVAR.

There are two different types of abdominal aortic aneurysm (AAA) surgery: open surgical repair and endovascular repair (EVAR). Open surgery is performed through a midline abdominal incision, has more blood loss than EVAR, and has a longer hospital stay than EVAR.  EVAR has become the gold standard procedure to effectively treat an AAA, even in complex anatomy, due to its quick recovery from surgery (usually two to four days after the procedure). EVAR often does not require any incisions at all but can be performed through the groin with wires and catheters.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.