Vascular

Abdominal Aortic Aneurysm Repair (Open)

ABDOMINAL AORTIC ANEURYSM REPAIR (OPEN)

Indication: AAA ≥5.5 cm in men (≥4.5–5.0 cm in women), symptomatic AAA of any size, or rapidly expanding AAA (>1 cm/year). Open repair selected when endovascular anatomy is unfavourable or patient preference.

Patient Position: Supine. Urinary catheter and arterial line placed.

Anaesthesia: General (with or without epidural). Blood products available. Cell saver used.

Incision: Midline laparotomy (transperitoneal) or left flank retroperitoneal approach. Retroperitoneal approach preferred for inflammatory aneurysms, hostile abdomen, or need for juxtarenal/suprarenal access.

Procedure:
1. Abdomen entered and viscera explored. Small bowel displaced to the right and superiorly, or packed.
2. Retroperitoneum opened over the aorta. Duodenum and left renal vein identified and protected.
3. Infrarenal aortic neck dissected and controlled with vascular clamps. Iliac arteries exposed and controlled distally.