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.
- 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.
- 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.
- On the transected aorta make the anastomosis with the parachute technique starting at the opposite side (3 or 9 o’clock).
- Always put the needle out-in on the graft.