Surgery Better Cost Effective Treatment Option for Chronic Ruptured Contained Abdominal Aortic Aneurysm
Journal Title: Journal of Cardiovascular Medicine and Surgery - Year 2017, Vol 3, Issue 1
Abstract
A chronic contained rupture of an abdominal aortic aneurysm (CCRAAA) is a well- documented subtype of abdominal aortic aneurysm (AAA) rupture in which the hematoma is sealed by the retro-peritoneum first described by Szilagyi et al. in 1961. Patients with a sealed AAA rupture often present a diagnostic and therapeutic dilemma as they lack the typical features of hemorrhagic shock usually seen with frank rupture. While AAA is a common disorder, CCR-AAA constitute only 4% of all ruptured aortic aneurysms.Treatmentvaries from stenting to open surgery or combination of both.But it is costly. We report a case of a 27 year-old Indian female who presented with a 6-month history of low back pain and a mass per abdomen. A contrast enhanced CT scan with an aortogram demonstrated a 8.8cm partially thrombosedpseudoanerysm just after the origin of superior mesenteric artery extending to both the common iliac artery.Patient was not affordable for stenting procedure so open surgery planned under GA. After left thoracoabdominal incision, as first step left common iliac artery to left renal artery grafting was done using 6 mm PTFE graft for maintaining the its blood supply after clamping aorta. After 200iu/kg heparinisation the descending thoracic aorto and femoral artery cannulated . ¾ th size tubing connected to both these canulla. Aorta clamped distal to canulla along with clamping both common iliac arteries.Aneurysm opened and large 8cm by 8cm aortic thrombus evacuated. End to end aortobiiliac grafting done using 24mm by 9 mm Y graft. Right renal artery anastomosed directly on the graft.Incision closed with two drains,one in abdomen and other in left chest.Patientextubated after 6 hours and discharged after ten days.Patients with low financial income - open surgery was the only valid and better option. Though it was difficult but with proper planning and protocols ,surgery seems to be easy with better results.
Authors and Affiliations
Suraj Wasudeo Nagre
Keywords
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- EP ID EP462248
- DOI 10.21088/jcms.2454.7123.3117.11
- Views 101
- Downloads 0
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