AAA greater than 5 cm in diameter with aneurysm neck angulation greater than 60°, which makes it unsuitable for EVAR.
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Dynamic three-dimensional spiral CT imaging of an infrarenal abdominal aortic aneurysm (AAA)
![Dynamic three-dimensional spiral CT imaging of an infrarenal abdominal aortic aneurysm (AAA)]()
Soundsettings -
Laparotomy
![Laparotomy]()
Soundsettings Perform a median laparotomy from the xiphoid down to the symphysis, carrying the incision around the umbilicus on the left side.
Tips:
1. Maintain adequate distance from the umbilicus and do not incise the skin tangentially, as this runs the risk of wound edge necrosis.
2. If the incision damages the cartilage of the xiphoid, it may trigger the development of a so-called scar bone (heterotopic ossification in the scar). Therefore, the incision should begin somewhat lateral to the xiphoid.
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Opening the retroperitoneum
![Opening the retroperitoneum]()
Soundsettings After exploring the abdomen, sweep the small intestine to the right and the transverse colon into the upper quadrants. Coagulate smaller vessels and open the retroperitoneum slightly to the right of the right iliac axis, sparing the inferior mesenteric artery (AMI) and the lymphatic pad. The incision runs along the right side of the AAA. Mobilise the duodenojejunal flexure.
Dissection of the iliac arteries and the aneurysm neck
Expose the right common iliac artery by dissecting directly on the vessel and mobilise the preaorti
Expose the right common iliac artery by dissecting directly on the vessel and mobilise the preaorti
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