After nearly four hours, the surgical team successfully removed the aneurysm, re-establishing blood flow through a synthetic graft. Circulation in both lower limbs recovered well, with no bleeding complications. The patient was monitored in intensive care, then recovered and was discharged.

The patient initially experienced dull abdominal pain and bloating, attributing it to digestive issues. When the pain intensified, he sought care at Nhan Dan Gia Dinh Hospital. Doctors suspected a dangerous vascular injury, and a computed tomography (CT) angiography revealed a large abdominal aortic aneurysm below the kidneys, threatening rupture in multiple locations.

The patient presented with several underlying conditions: carotid artery stenosis over 50% (posing a stroke risk with fluctuating blood pressure), chronic obstructive pulmonary disease (COPD) leading to impaired respiratory function. He also had stage 4 chronic kidney disease, nearing the need for dialysis, making him highly sensitive to contrast agents and intraoperative anemia.

Doctors from multiple specialties consulted, considering endovascular aneurysm repair (EVAR) with a stent graft. However, the patient's vascular system was severely calcified, with narrow and tortuous lumens. These conditions rendered it unsuitable for delivering instruments to the lesion, necessitating a switch to open surgery to resect the aneurysmal segment and replace it with a synthetic graft.

On 6/7, Associate Professor Doctor Tran Minh Bao Luan, Deputy Head of the Department of Thoracic and Vascular Surgery, stated that the biggest challenge involved controlling and suturing blood vessels below the kidneys. The vessel wall was atherosclerotic and prone to tearing, meaning even minor deviations could cause uncontrollable bleeding. The team had to ensure precise sutures and stable hemodynamics throughout the surgery.

Due to complex conditions, endovascular intervention was not possible, and the patient underwent open surgery with a long incision. *Photo: Hospital provided*.

According to Master Doctor Nguyen Hung Truong of the Department of Thoracic and Vascular Surgery, an abdominal aortic aneurysm is a silently progressing disease. It often presents with no clear symptoms in its early stages and is typically discovered incidentally during routine health check-ups or ultrasounds. The condition is dangerous because rupture can cause massive blood loss, leading to a very high mortality rate if not treated promptly with surgery.

Doctors recommend that individuals over 50 years old, especially those with hypertension, dyslipidemia, atherosclerosis, or a long history of smoking, undergo regular abdominal ultrasound screenings every 6-12 months for early detection. Warning signs include dull pain in the abdomen or back, and a pulsating sensation in the abdomen. Sudden severe abdominal pain, dizziness, and sweating may indicate a ruptured aneurysm, requiring immediate emergency medical attention.

In addition to screening, doctors advise maintaining a healthy lifestyle: controlling blood pressure and blood sugar, limiting tobacco use, and adopting a low-salt, low-saturated fat diet to protect the vascular system.

By Le Phuong