Technical problems and conceptual solutions

The distinguishing characteristics of large and giant aneurysms, in addition to their size, are the unusual nature and broad extent of aneurysm neck and the high frequency of intraaneurysmal calcification and thrombosis. These factors force the surgeon to rely heavily on special modifications of routine surgical approaches to facilitate exposure of the aneurysm-bearing arterial segment. Successful definitive clip reconstruction of such lesions often mandates the use of protracted temporary local arterial arrest, extensive aneurysmorraphy, and application of multiple aneurysm clips of varying configurations.