Open Repair of Ruptured Abdominal Aortic Aneurysm

Abstract

Early transportation to the operating room, prompt diagnosis by aortic ultrasound/CTA, and immediate proximal control are obtained by exposure of the supraceliac aorta in patients with large retroperitoneal hematoma and those presenting with shock. In patients presenting with a small- or a moderate-sized hematoma, proximal control is obtained by finger dissection under the left renal vein and proximal clamp is applied to the aorta at that level. If a patient becomes extremely hypotensive during pararenal dissection, a large Foley catheter (28 Fr) with a 30 cc balloon should be advanced into the lower thoracic aorta guided by the index and middle finger of the right hand. In patients who may be candidate for endovascular repair, a 12 F sheath is interested in to the common femoral artery and a large aortic balloon is inflated over the guide wire at the supraceliac level to obtain proximal control, and an aortogram is obtained in the hybrid operating room to decide between open or endovascular repair. In patients undergoing open repair, distal control is obtained at iliac artery site, following proximal control, and the repair proceeds as in repair of an unruptured abdominal aortic aneurysm.