Editing Open AAA repair (section)

== Transabdominal AAA repair ==
Setup

* Supine with arms out
* Prep from nipples to knees

Approach

* Midline laparotomy
* Omentum and transverse colon brought cephalad
* Root of mesentery and small bowel retracted to right and maintained with retractor like Omnitract
* Divide ligament of Treitz and retroperitoneum tissues over aneursym itself
** Avoid injury to IMV, but can be ligated if necessary
** Track the right of the aorta to avoid injury to IMA, sigmoid mesentery and autonomic nervous plexus at the bifurcation
**
* If the aneurysm itself is covered by left renal vein, may need to ligate the branches to retract it superiorly

Supracoeliac clamping

* Most useful in setting of ruptured AAA or juxtarenal AAA
* Requires specific steps
* Consider renal preservation therapy
* Aim clamp time <30mins

Aortic repair

* Aortic sac opened longitudinally, and mural thrombus and debris are evacuated with care
* Reconstruction with appropriate Dacron or polytetrafluoroethylene (PTFE) tube grafts
* Cover graft with aortic sac and omentum to reduce migration

Closing

* Careful haemostasis - look at intercostals and lumbar vessels