title: Axillomesenteric bypass: an unusual solution to a difficult problem.
abstract: A 49-year-old woman presented with acute anuric renal failure and severe hypertension. Imaging revealed occlusion of the distal thoracic and abdominal aorta. Acute hemodialysis and reduction in blood pressure precipitated an acute exacerbation of previously undiagnosed mesenteric ischemia. Repeated episodes of flash pulmonary edema and a generally parlous clinical condition precluded thoracoabdominal reconstruction. As a result, a left axillomesenteric bypass was performed as a substitute, using a 6-mm externally ringed PTFE graft. She made an uneventful recovery, and her abdominal symptoms resolved swiftly. The patient remains symptom-free 12 months postoperatively. In this rare situation, extra-anatomic bypass provided an unorthodox but less-invasive solution to a difficult surgical problem.
authors.affiliation: Department of Vascular and Endovascular Surgery, Leicester Royal Infirmary, Leicester, United Kingdom. ckarkos@hotmail.com
authors.forename: Christos D
authors.initials: CD
authors.lastname: Karkos
authors.forename: Greg S
authors.initials: GS
authors.lastname: McMahon
authors.forename: George
authors.initials: G
authors.lastname: Markose
authors.forename: Robert D
authors.initials: RD
authors.lastname: Sayers
authors.forename: A Ross
authors.initials: AR
authors.lastname: Naylor
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology; D001002:Anuria / Q000209:etiology; D001012:Aorta, Abdominal; D001013:Aorta, Thoracic; D001018:Aortic Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography; D001157:Arterial Occlusive Diseases / Q000601:surgery; D001158:Arteries / Q000601:surgery; D001365:Axilla / Q000098:blood supply*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D005260:Female; D005704:Gallbladder / Q000098:blood supply*; D006801:Humans; D006973:Hypertension / Q000209:etiology; D007421:Intestine, Small / Q000098:blood supply*; D007511:Ischemia / Q000209:etiology*; D017538:Mesenteric Artery, Superior / Q000601:surgery; D008641:Mesenteric Vascular Occlusion / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011474:Prosthesis Design; D011654:Pulmonary Edema / Q000209:etiology; D014057:Tomography, X-Ray Computed
chemical_list: D011138:Polytetrafluoroethylene