Vascular

Ruptured Abdominal Aortic Aneurysm Repair (Emergency Open)

RUPTURED ABDOMINAL AORTIC ANEURYSM REPAIR (EMERGENCY OPEN)

Indication: Clinical diagnosis of ruptured AAA (classic triad: back pain, hypotension, pulsatile abdominal mass). Immediate operative intervention without delay for imaging in haemodynamically unstable patients. Permissive hypotension (systolic 70–80 mmHg) maintained until aortic control achieved.

Patient Position: Supine. Large-bore IV access, arterial line, Foley catheter. Operating team and scrub team prepared before anaesthetic induction (induction may precipitate cardiovascular collapse).

Anaesthesia: General. Blood products (packed red cells, FFP, platelets) pre-prepared. Cell saver used.

Incision: Rapid midline laparotomy.

Procedure:
1. Rapid midline laparotomy. Immediately on entering the abdomen: if free intraperitoneal haemorrhage present, manual compression of the aorta at the supracoeliac level (below the diaphragmatic crura) to obtain proximal control while anaesthesia team resuscitates.