A large aneurysm of the aorta at the level of the occluded renal arteries in a poor patient who is getting dialysis in a Govt general hospital through special health scheme (ARSR).

It is difficult and a Challenge to manage a large abdominal aortic aneurysm very close to (involving) the superior mesentric artery (SMA) in a patient who is getting hemodilaysis through a neck jugular line in the Govt hospital without significant morbidity and mortality. The CT scan is showing (see fig) a large aneurysm >10cm and intra vascular thrombus, and the patient has pre-rupture symptoms. The Govt scheme (ARSR) is supporting such treatments providing financial help up to Rs 1.25 Lakhs. The total care of such patients along with dialysis may be costing more than that and private hospitals will not be willing to take up such cases. The Govt hospitals are not in a position to take up such cases. It is very unlikely that centers will be coming forward to take these challenging operations without adequate financial planning.