Open surgical aneurysm repair is performed in an operating room under general anesthesia. This traditional surgical approach involves making a large incision to reach the aorta. A surgeon clamps off the aorta, removes the diseased or injured part of the aorta, and sews in a plastic graft to act as a bridge for the blood flow. 

Grafts are made of various materials, such as Dacron (textile polyester synthetic graft) or polytetrafluoroethylene (PTFE, a non-textile synthetic graft). The graft connects one end of the aorta at the site of the aneurysm to the other end of the aorta.

To protect the brain and central nervous system during certain types of open aortic surgery, hypothermic circulatory arrest (HCA) may be done. This involves lowering the body’s temperature, which reduces the body’s need for blood flow and oxygen, allowing the surgeon to work on certain parts of the aorta that would otherwise be impossible. The brain can be further protected in these procedures by a technique called selective brain perfusion.

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