Open surgical repair of an abdominal aortic aneurysm is a major operation performed under general anaesthesia (with you asleep). The first part of your procedure involves administering the anaesthetic. A tube will be placed into your air pipe once you have been anaesthetised and connected to a mechanical ventilator which will breathe for you during the operation. Additionally, you will have a tube (catheter) inserted into your bladder to drain your urine. This facilitates accurate assessment of your hydration status during and immediately after the operation. The anaesthetist will furthermore insert a small tube into an artery in your wrist to enable accurate measurement of your blood pressure during your operation. In order to minimise pain after the operation as much as possible, the anaesthetist may place a catheter in the epidural space of your spinal cord - an epidural. This catheter will be connected to a pump for continuous administration of pain-busting drugs during the first 4-5 days after surgery that numb the nerves supplying the area of the abdominal incision. In case of contra-indications for epidural catheter placement, your surgeon may opt to place a catheter for pain relief in your abdominal wall at the end of the procedure. Once the necessary monitoring equipment has been connected your surgeon will start the operation. At Circulation Clinic we undertake all open AAA repair procedures as a joint case with two of our experienced consultants operating together. This reduces the time taken to perform the operation and thereby the time you are under general anaesthesia. We strongly believe this improves outcomes and reduces the risk of a variety of potential complications including heart attacks, kidney failure, respiratory complications and infection rates. Through a transverse or midline laparotomy the surgeons will gain access to your abdominal cavity. After a brief inspection of the abdominal cavity (to ensure that nothing untoward is found that was not evident on pre-operative invesitgations/imaging), they will proceed to expose the aorta and both common iliac arteries. Depending on the extent of the aneurysm proximally and distally, they may have to expose the renal arteries proximally or gain access to your femoral arteries in the groin. Once adequate exposure has been achieved an aortic clamp will be placed proximally. Ideally this is placed below the renal arteries, so that the kidneys remain perfused during the operation. However, in selected cases your surgeons may deem it necessary to clamp the aorta above the renal arteries, thereby temporarily interrupting the blood flow to your kidneys. The aneurysm is then opened and replaced with a tubular or bifurcated polyester graft which is stitched onto the aorta with a non-absorbable suture. Depending on the extent of the disease, the distal anastomosis (join) is made at the level of the aortic bifurcation (tubular graft), or both iliac arteries/both common femoral arteries (trouser graft). Following the aortic reconstruction all wounds are repaired in layers with stitches. If you have not been given an epidural catheter, your surgeon will now place catheters in your abdominal wall for post-operative pain relief. Drains may be inserted into the groin wounds to drain any excess fluid that may accumulate in the immediate post-operative period. After the operation you will be transported to the Intensive Care Unit (ICU). Depending on how well you are at the end of the operation, the ICU team will try to wake you up as soon as possible. However, they may deem it necessary to keep you sedated for one day (or longer) following the operation. One or two days after the operation you should be well enough to be transferred to the ward where you will stay 4-5 more days until you are fit for discharge.