Open surgical repair of a giant abdominal aortic aneurysm

Abdominal aortic aneurysm (AAA) is more common at 50–60 years of age although it can be seen in any age stage of life [1]. The most important factor in the pathogenesis is elastin and collagen degeneration in the media layer. Aneurysm may be associated by collagen degeneration or autoimmune diseases such as Marfan syndrome, Takayasu’s arthritis, giant cell arthritis, temporal arthritis and Behçet’s disease [2]. The majority of cases are asymptomatic and are detected during physical examination or imaging performed for other reasons.
AAA presents as back pain, abdominal pain, leg pain or abdominal distention. Ultrasonography (USG), computed tomography (CT) or magnetic resonance imaging (MRI) is used for diagnosis. The most serious complication of AAA is rupture. Mortality rates in aortic rupture reach up to 90% [3]. The risk of rupture is high in aneurysms greater than 5 cm, aneurysms growing faster than 0.5 cm per year or in painful AAAs. Treatment is indicated for patients in this group either with open surgery or an endovascular method [3].
A case of infrarenal AAA, with a diameter of 15.8 cm in a 64-year-old male patient, is presented here. Open surgical repair using an aorto-biiliac Y graft interposition was opted for and the patient was discharged successfully on the tenth postoperative day.
A 65-year-old male patient with complaints of abdominal bloating, severe abdominal and back pain and a palpable mass in the abdomen was referred to the emergency department. His past medical history included hypertension, chronic kidney disease, chronic constipation and coronary artery bypass grafting. He had ignored his symptoms and has not applied to any hospitals for 2 years. Abdominal USG revealed an infrarenal abdominal aortic aneurysm with a diameter of 9.5 cm.
On physical examination, blood pressure was 125/80 mm Hg and pulse was 80/minutes. The bowel sounds were normal. There was a pulsatile mass in the umbilical region that was tender on palpation. Upper and lower extremity distal pulses were palpable. Neurological examination was normal.
The patient was followed up in the intensive care unit. Following arterial and rhythm monitoring, blood pressure and rhythm control were achieved by intravenous beta blocker administration. Opioid pain killers were preferred for the pain control. Monitoring of the hematocrit levels at 2-hour intervals did not display any decrease. The patient underwent thoracoabdominal CT angiography, which...


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