Novel visceral reconstruction for paravisceral aortic aneurysm complicated with aortoiliac occlusion.
Visceral ischemia is a serious factor in the postoperative morbidity and mortality of suprarenal aortic reconstruction. We report a case of a patient who underwent surgical repair for a paravisceral aortic aneurysm complicated with aortoiliac occlusion, using a novel visceral reconstruction. Prior to proximal anastomosis of the aorta, we reconstructed visceral arteries by bypass grafting to the superior mesenteric artery and right renal artery (RA), using a straight 12-mm prosthetic graft originating from the intact descending aorta. During the visceral reconstruction, selective cold crystalloid perfusion of the RA was performed. We then underwent the proximal anastomosis of the aorta just below the celiac trunk using a Y-shaped prosthetic graft 18×10 mm in diameter, in keeping the adequate visceral perfusion. Finally, a femoro-femoral bypass was performed with an 8-mm Gore-Tex Vascular Graft, and the left limb of the Y-shaped graft was sewn onto the side of this prosthetic graft. Postoperative computed tomography (CT) identified the successful repair of the aneurysm without any complications. Our novel visceral reconstruction could allow the surgeon to provide a physiological perfusion of visceral organs and prevent the potential visceral ischemia, during suprarenal aortic reconstruction.
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2(E1) Yamadaoka, Suita, Osaka 565-0871, Japan.
Satoshi
S
Kainuma
Toru
T
Kuratani
Kazuo
K
Shimamura
Yoshiki
Y
Sawa
D000714:Anastomosis, Surgical / Q000379:methods; D001012:Aorta, Abdominal / Q000473:pathology; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007083:Iliac Artery / Q000473:pathology; D021621:Imaging, Three-Dimensional / Q000379:methods; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods; D012078:Renal Artery Obstruction / Q000000981:diagnostic imaging / Q000601:surgery*; D018570:Risk Assessment; D013152:Splanchnic Circulation / Q000502:physiology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods