Open Aneurysm Surgery: Procedure, Recovery and Outlook

Written and medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: November 2026 · How we review

Quick Answer

Open aneurysm surgery is the traditional way to repair an aortic aneurysm, a weak, bulging area in the body's main artery, by replacing the damaged section with a fabric tube (graft). Planned surgery is advised when an aneurysm reaches about 5 to 5.5 cm. Emergency surgery is needed if it ruptures. Recovery takes four to six weeks or more.

What the research says

• Open repair had better long-term survival than EVAR: a review of 13 studies with nearly 27,000 people found endovascular repair (EVAR) had better survival in the first 11 months, but open repair had better survival after that and fewer repeat procedures (Loufopoulos G et al., Journal of Endovascular Therapy, 2025) [2]

• Small aneurysms didn't need early surgery: a Cochrane review of 4 trials with 3,314 people with 4.0 to 5.5 cm aneurysms found early repair (open or endovascular) gave no long-term survival advantage over ultrasound monitoring (Ulug P et al., Cochrane Database of Systematic Reviews, 2020) [3]

Key takeaways

• Open aneurysm surgery replaces a bulging section of the aorta with a graft.

• It's usually advised at about 5 to 5.5 cm or with fast growth.

• Surgery takes three to four hours.

• Recovery takes four to six weeks or more.

• Planned surgery has a 95% to 98% survival rate.

What is open aneurysm surgery?

An aortic aneurysm can rupture or tear, which is life-threatening. Open surgery works best before rupture. A less invasive option is EVAR, which places a stent graft through the groin. Sources: [1]

When it's needed

People with Marfan syndrome may need surgery sooner.

Situation	Details
Planned	Aneurysm about 5 to 5.5 cm or larger, growing over 1 cm a year, or causing symptoms
Emergency	A ruptured or dissected aneurysm
Instead of EVAR	When a stent graft won't fit the aorta's shape

People with Marfan syndrome may need repair at a smaller size. Sources: [1, 3]

Emergency warning signs

Call 911 for sudden severe belly, back or leg pain, tearing chest or back pain, fainting, dizziness, a fast heartbeat, shortness of breath or clammy skin. Sources: [1]

Types of open repair

A thoracic or vascular surgeon performs it.

• Thoracic repair: for aneurysms in the chest.

• Abdominal repair: for aneurysms in the belly. Sources: [1]

How to prepare

• A physical exam and tests weeks ahead.

• Review your medicines and supplements; some may need stopping.

• Control conditions like high blood pressure.

• No smoking for at least a month before.

• Nothing to drink after midnight, and arrange a ride home. Sources: [1]

What happens during surgery

It usually takes three to four hours.

1. You get general anesthesia.

2. A long incision is made in your chest or belly.

3. Clamps stop blood flow above and below the aneurysm.

4. A heart-lung machine may keep blood flowing.

5. The bulging section is replaced with a graft sewn into place.

6. The incision is closed. Sources: [1]

Risks

• Bleeding or blood clots.

• Breathing problems.

• Damage to the intestines or other organs.

• Heart attack or stroke.

• Graft or other infections.

• Kidney failure.

• Nerve or spinal cord injury. Sources: [1]

Risk is higher with heart, kidney or lung disease, a past stroke or older age. Sources: [1]

Recovery

• You'll spend several days in the ICU and 5 to 10 days in the hospital.

• Full recovery takes four to six weeks, or up to two to three months.

• No lifting over 10 pounds for four to six weeks.

• Don't drive until cleared.

• Hug a pillow over your incision when you cough.

• Expect less appetite and tiredness for a few weeks. Sources: [1]

Outlook

Survival with planned surgery is 95% to 98%, and most people fully recover. Survival after surgery for a ruptured aneurysm is 50% to 70%. Sources: [1, 2]

When to call your provider

• Redness, warmth, swelling or drainage at the incision.

• Severe back or belly pain.

• Swollen legs or trouble moving them.

• Chest pain or shortness of breath.

• Fever, chills or blood in your stool. Sources: [1]

Conclusion

Open aneurysm surgery is a durable way to fix a dangerous aortic bulge before it ruptures. Regular monitoring helps time surgery safely.

Keep learning: read about EVAR and aortic aneurysms.

Frequently asked questions

What is open aneurysm surgery?

Surgery that replaces a bulging section of the aorta with a graft.

When is surgery needed?

Usually at about 5 to 5.5 cm, with fast growth or after rupture.

What is the graft made of?

Strong artificial fabric, such as polyester.

How long does surgery take?

About three to four hours.

How long is the hospital stay?

About 5 to 10 days.

How long is recovery?

Four to six weeks, sometimes two to three months.

Is EVAR better?

EVAR is less invasive; open repair may last longer.

What's the survival rate?

95% to 98% for planned surgery.

Can I lift things afterward?

Not over 10 pounds for four to six weeks.

Do small aneurysms need surgery?

Often not; they can be monitored.

Related Reading

Aortic Aneurysm: Types, Causes, Dissection Risk & Complete Guide aortic aneurysms.

Endovascular Aneurysm Repair (EVAR): Procedure, Recovery, Risks and Benefits the less invasive option.

Thoracic Aortic Aneurysm Surgery: Open Repair vs. TEVAR, Risks and Recovery chest aneurysm repair.

Abdominal Aortic Aneurysm (AAA) Screening: Who Needs It, How It's Done and What Results Mean finding aneurysms early.

Aortic Dissection: Emergency Warning Signs, Types, Diagnosis & Treatment a tear in the aorta.

References

1. Cleveland Clinic. Aneurysm Surgery: Procedure Details and Recovery. Cleveland Clinic. Last updated April 25, 2022. https://my.clevelandclinic.org/health/treatments/16735-aneurysm-surgery-traditional-open-surgery

2. Loufopoulos G, Tasoudis P, Koudounas G, et al. Long-term outcomes of open versus endovascular treatment for abdominal aortic aneurysm: systematic review and meta-analysis with reconstructed time-to-event data. Journal of Endovascular Therapy. 2025;32(4):946-956. PMID 37855415. https://doi.org/10.1177/15266028231204805

3. Ulug P, Powell JT, Martinez MA, et al. Surgery for small asymptomatic abdominal aortic aneurysms. Cochrane Database of Systematic Reviews. 2020;7(7):CD001835. PMID 32609382. https://doi.org/10.1002/14651858.CD001835.pub5

Medical disclaimer

This article is for general education only and does not replace advice from a qualified healthcare professional. Talk to your doctor about your own diagnosis and treatment, and seek emergency care right away for severe or sudden symptoms.