What is the preparation for open aortic aneurysm repair?

What's the preparation for open aortic repair? Okay so open aortic repair is quite a big undertaking and most vascular surgeons should be in a position to adequately counsel their patients as to which treatment they should go for. in an ideal world, a vascular surgeon should be familiar with both endovascular repair and competence at endovascular as well as open repair. In other words, there should be equipoise and that allows the surgeon to, you know, basically place the patient's interest at heart rather than selecting necessarily a technique that they're more familiar with. that's the ideal circumstance. So the first part of preparation really for aneurysm repair is discussion with the patient counselling and explaining exactly what an aneurysm is, and explaining the modalities of treatment, bearing in mind that the modalities of treatment can also include not operating on the patient. So that's the first bit. And then the second bit is down to the surgical and anaesthetic teams is a an in-depth assessment of the patient's fitness for surgery. So we need to look at how well the patient's heart is working and how well their lungs are working in particular. Vascular patients by virtue of the fact that they've got vascular disease frequently have disease affecting other arterial territories, in other words the heart and the brain. So there are, this cohort of patients is at increased risk of conditions such as heart attack or stroke. So we need to assess those areas in depth. We also need to be able to assess their ability to withstand a fairly complex and invasive open surgery. Then once we've done that and we've got a reasonable assessment of the patients, you know, their physiology and how well their circulatory and respiratory systems will support their repair, we can then go on to undertake what is a more complex assessment of their anatomy or their morphology to work out, you know, whether they are indeed suitable for stent grafts or the keyhole intervention. So, ideally, both of these factors should happen at the same time and the aim of the surgeon really is to gain as much information about the patient's anatomy as well and their physiology in order to make a balanced decision and then usually with that data at hand ultimately the treatment is discussed in what's referred to as a multidisciplinary team and the decision is reached as to which modality to go down, whether that's open surgery or endovascular intervention.