Vascular

Abdominal Aortic Aneurysm Repair (Open) (Ruptured)

OPERATION: Open Repair of Ruptured Abdominal Aortic Aneurysm
ANAESTHETIC: General anaesthesia — induction deferred until ready to incise
ANTIBIOTICS: IV antibiotics at induction
POSITION: Supine. Patient prepared and draped awake — abdomen and groins. Urinary catheter inserted pre-induction. Permissive hypotension (target ~70 mmHg systolic) maintained until proximal control achieved.

INDICATION:
Ruptured / suspected ruptured AAA. [CT confirmed / clinical diagnosis in extremis]. Large-bore IV access, arterial line, urinary catheter, cross-match. [Cell salvage in circuit].

PROCEDURE:
Patient induced only when team and scrub ready. Midline laparotomy. Small intestine retracted laterally by assistant. Retroperitoneum rapidly entered.

PROXIMAL CONTROL:
Left renal vein and renal arteries identified. Proximal infra-renal clamp applied as rapidly as possible. [Supra-coeliac clamp applied temporarily if patient in extremis.] Iliac vessels clamped successively.

Repair then proceeds as per elective open AAA repair:
- Sac opened, thrombus evacuated