Giant abdominal aortic aneurysm treatment with open surgery in a risky patient post CABG with stenotic coronaries

A 70 year-old syrian refugee male was admitted with history of a heavy smoking, post operative CABG operation of which 2 years ago with an open RCA graft but LAD %100 proximally plaque stenosis, %90 CX and multiple branch occlusions without angina with normal ejection fraction and normal valve functions. At the angiography no other grafts were observed and no epicrisis was obtained. He could not take any food because of vomiting and lose of weight day by day recently and with complaints of exceeding abdominal discomfort, increasing back pain and physical mobility discomfort in recent months duration. Physical examination revealed a giant, prominently visible, expansile, pulsatile, well-defined, nontender abdominal mass in the whole abdominal area. Computed Tomographic (CT) and angiography revealed a large infrarenal aortic giant aneurysm with a maximum transverse diameter of 13.6 cm without iliac extensions. Anatomy of the aneurysm did not permit Endo-Vascular Aneurysm Repair (EVAR). The patient underwent open surgical inclusion repair using an, aorto-bi-femoral 16 mm ﾗ 8 mm collagen-impregnated bifurcated Dacron graft. Postoperative recovery was uncomplicated and he discharged at the 10th day from the hospital with no complaints and with good health. Histopathologic study is non significant.