• Cross-clamp level + clamp/unclamp physiology

• unable to perform endovascular repair
  • poor vascular access, unable to delivery stent
  • previous surgery, eg. fem-fem cross-over for previous occluded FA

• C = Cardiovascular
  • Haemorrhage
  • Haemorrhagic shock = high mortality 85%
• E = Endocrine
  • Hypothermia
• F = Renal
  • Large fluid shifts

• Pre-op
  • co-morbidities = CAD, HTN, DM, CKD, COPD, smoking
  • caution urgent procedure = unfasted, unoptimised
    • Time-sensitive
  • extra help = second anaesthetist
• Intra-op
  • Need CVC for GTN/SNP/NAd
  • ⬆Risk bleeding > EVAR
  • C = adequate resuscitation
  • C = manage HDI with aortic cross clamping/un-clamping
    • See separate document
  • E = Endocrine
    • Do not warm ischaemic limbs
      • Warm legs after clamps off
• Post-op
  • monitor in ICU

Ruptured AAA

• Anticipate crash on induction
  • Cardiovascular collapse
  • Ex-sanguination
  • Loss of tamponade when abdomen is opened
• Massive transfusion
  • Similar to a trauma bleed / code crimson
  • IV access = Swan sheath / RIC / Vascath
  • Blood bank
  • Cell saver
• Induction
  • Similar to GA CS
  • Patient must be prepped and draped and surgeons scrubbed
• Much less common now
  • More intervention and less surveillance / observation

Renal ischaemia

• Number 1 = minimise cross-clamp time
• The other options are far less effective
• Others
  • Euvolaemia / maintain PL