Open Repair Of A Giant 18cm AAA: A Case Report And Review Of Literature
Joshua Ng, MSE, Tuong Nguyen, MD, Dawn Salvatore, MD, FACS, Paul DiMuzio, MD, FACS, Babak Abai, MD, FACS.
Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Giant abdominal aortic aneurysms (AAAs) have a variable definition in literature ranging from greater than 10-13 cm in maximum transverse diameter. Regardless of the diameter used for this classification, AAAs of this size are rare and present unique challenges for management. We present a case of a 68 year old male with a long history of smoking and alcohol use presenting with an incidentally found 18cm AAA. Given poor anatomy for endovascular repair, this patient was taken to the OR for an open para-renal repair with a rifampin soaked dacron graft. Endarterectomy of the right common iliac was also performed given occlusion seen on imaging. The patient did well post-operatively and was discharged on post op day 5. He was doing well at 1 month followup. We also conducted a literature review of 40 patients with Giant AAA defined as maximum diameter greater than 10cm. The demographics were similar to known risk factors of increasing age, male gender, smoking, and hypertension. 30 percent of the patients presented with rupture. Open technique was the preferred intervention with only 4 endovascular repairs attempted. In summary, Giant AAAs are a rare clinical entity. They present unique anatomical challenges that favor open repair over EVAR.
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