Open Repair of Infrarenal Abdominal Aortic Aneurysm: A Stepwise Approach

A seventy-six-year-old woman who is non-diabetic and a non-smoker presented with complaints of abdominal pain and was diagnosed with a thrombosed infrarenal abdominal aortic aneurysm. She was planned for open repair due to tortuosity of aneurysm and financial constraints.

First, a midline laparotomy was done, and the bowel was retracted using warm, moist sponges. The aneurysm was exposed, and proximal and distal vascular clamps were placed. The sac was then incised and the clots were evacuated. The back bleeding lumbar vessels were ligated. A cell saver device was used during the procedure as a blood conservation strategy.

Next, an 18 mm Dacron graft was interpositioned between the infrarenal aorta and just above its bifurcation using 4-0 polypropylene sutures. The sac was then closed over the graft to provide additional support. The peritoneum was closed, and the abdomen was closed in layers. The postoperative period was uneventful, and the patient was discharged home on the fifth postoperative day.