Ruptured Abdominal Aortic Aneurysm Repair Using Open Proximal Anastomosis Under Deep Hypothermic Circulatory Arrest

Proximal aortic clamping under normothermia is generally adequate for operative repair of abdominal aortic rupture; however, the hypothermic circulatory arrest (HCA) technique is not as common. Proximal exposure and clamping are sometimes difficult due to the risk of bleeding, rerupture, and ischemia. We present a successful case of a ruptured abdominal aortic aneurysm (AAA) that was repaired using cardiopulmonary bypass with HCA. A 75-year-old man presented with sudden back pain and was diagnosed with a ruptured AAA using computed tomography. The aneurysm had a maximal diameter of 100 mm and protruded anteriorly just below the renal arteries. The rupture site was close to the renal arteries, and thus, there was a high risk of bleeding and shock during proximal exposure. Cardiopulmonary bypass was established by cannulation of the right axillary artery and right femoral vein, following which open laparotomy was performed. Proximal exposure and anastomosis could be safely performed using HCA. This cardiopulmonary bypass with HCA technique may be useful as a surgical strategy for ruptured juxta-renal AAAs.