This article is part of the operation script for grafting an abdominal aortic aneurysm. The article can be used on its own, or to go to the next part of the operation, click on NEXT PART OF THE OPERATION at the bottom of this page.
AORTIC ANEURYSM 200 SECTION 8.00 - ASSESSING THE ANEURYSM
STEP 8.01 CHECK THE AIMS OF THE ASSESSMENT
- The aims are:
- To confirm that the aneurysm is the cause of the patient’s condition.
- To show that the aneurysm does not involve the renal arteries.
- To decide about using a straight graft or a trouser graft.
- At the same time
- You will be identifying a 2-3 cm. length of relatively normal aorta above the aneurysm.
- You will also be clearing the site for applying an aortic clamp here.
STEP 8.02 PALPATE THE UPPER END OF THE ANEURYSM
- You need to confirm that the aneurysm is subrenal i.e below the renal arteries.
- This should have been suggested by the scans.
- You should be able to do this within 15 seconds or so.
- In more than 50% of cases:
- You will be able to feel a normal or acceptable aorta less than 25mm. diameter below the fourth part of the duodenum.
- This is a clear indication to continue.
STEP 8.03 PALPATE THE AORTA ABOVE THE TRANSVERSE COLON
- If the aorta is obviously more than 50 mm. at this level:
- Consider closing the aorta off below the renal arteries and performing axillo-bifemoral grafts.
- Consider abandoning the operation.
- Go to SECTION 24.00 CLOSING THE ABDOMEN.
- If the aorta seems to be less than 50mm.:
- You need to mobilise the 4th part of the duodenum and to see the left renal vein and the renal arteries.
- This mobilisation is also needed for clamping the aorta.
- Sometimes the suprarenal aorta is wider than normal.
- i.e More than 20mm. diameter, but less than 30cm.
- This does not preclude a grafting operation.
- Amend the operation plan as needed.
- If the aneurysm is leaking:
- A direct approach to the upper end of the aneurysm is the fastest way to clamping the aorta.
- In an elective case:
- There is plenty of time to identify the rest of the aneurysm , since this may give a better access to the upper end of the aorta.
