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  • Symptomatic or ruptured abdominal aortic aneurysm (AAA) of any size.
  • Asymptomatic AAA ≥ 5.5 cm or > 0.8-cm growth in 12 months.

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Absolute

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  • None.

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Relative

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  • Malignancy with limited life expectancy.
  • Prohibitive medical comorbidities.

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Open Repair

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  • Anterior approach: the patient should be supine, with a lumbar roll placed to allow for better aortic exposure and arms extended on arm boards.
  • Retroperitoneal approach: the patient should be in left lateral decubitus position.

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Endovascular Repair

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  • The patient should be supine on the angiotable, with both arms tucked or extended.

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Both Procedures

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  • A nasogastric tube is inserted.
  • A Foley catheter is placed.
  • Distal pulses are marked.
  • Two large-bore intravenous lines are placed to provide for rapid infusion.
  • A radial arterial line is placed for hemodynamic monitoring.

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Open Repair

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  • Patients usually are extubated in the operating room or within the first 12 hours and out of bed by postoperative day (POD) 1.
  • The typical patient requires up to 2 days in the ICU.
  • During the first 24–48 hours, patients require adequate fluid resuscitation.
  • We recommend aggressive diuresis of uncomplicated patients starting on POD 3 to prevent cardiac and pulmonary complications.
  • All central venous lines and arterial catheters should be removed as early as possible to decrease the risks of catheter-related infections.
  • The nasogastric tube may be removed on POD 1 or according to physician preference.
  • Most patients who have uncomplicated procedures are ready for discharge home by POD 7.

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Endovascular Repair

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  • Patients are extubated in the operating room.
  • Patients should be assigned to a telemetry floor bed.
  • Most patients with uncomplicated procedures are ready for discharge by POD 1 or 2.

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Open Repair

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Intraoperative Complications

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  • Injury to the small bowel, colon, ureter, or major venous structures.

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Postoperative Complications

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  • Myocardial infarction.
  • Bleeding.
  • Infections, including urinary tract or wound complications.
  • Pneumonia.
  • Bowel ischemia (particularly of the descending and sigmoid colon).
  • Lower extremity ischemia from distal embolization, thrombosis, or clamp injuries.
  • Renal failure.

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Endovascular Repair

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Intraoperative Complications

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  • Malposition of the graft.
  • Arterial dissection or rupture.
  • Avulsion of iliac arteries.
  • Endoleaks.

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Postoperative Complications

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  • Myocardial infarction.
  • Infections, including urinary tract or wound complications.
  • Pneumonia.
  • Bowel ischemia (particularly of the descending and sigmoid colon).
  • Lower extremity ischemia from distal embolization, thrombosis, or clamp injuries.
  • Renal failure.

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