The open repair of a dissecting aneurysm is different than the repair of a usual atherosclerotic aneurysm.  The dissected aortic wall may be fragile to support the graft suturing with safety.  I present a few thoughts after a repair of a ruptured dissecting AAA on a 60 year-old male. The procedure was performed by Prof GG and me and John Theodos assisting.

  1. Transect the aorta. Performing the proximal anastomosis on a transected aorta is better than using the usual inlay technique. This way, full thickness aortic bites can be taken.
  2. Try to identify the true lumen and reconstruct the normal aortic wall. This way the proximal anastomosis is performed on an anatomically almost intact wall, reinforcing its power.
  3. On the transected aorta make the anastomosis with the parachute technique starting at the opposite side (3 or 9 o’clock).
  4. Always put the needle out-in on the graft.

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