title: Ascending aorta-common hepatic artery bypass for mesenteric revascularization.
abstract: BACKGROUND
  Chronic aortic occlusion usually occurs from the infrarenal branch to the terminal aorta. We report the case of a patient with an occlusion that began at the suprarenal artery, and there was also occlusion of the superior mesenteric artery and extreme stenosis of the celiac artery. Antegrade bypass from the ascending aorta to the common hepatic artery was performed.
  
  
  METHODS
  A 59-year-old patient presented to our hospital with uremia due to acute anuric renal failure and anorexia. CT revealed long-segment occlusion of the thoracoabdominal aorta including the superior mesenteric artery and bilateral renal arteries. Additionally, there was high-grade stenosis in the celiac artery. We treated the patient using an antegrade bypass from the ascending aorta to the common hepatic artery. His recovery and postoperative course were uneventful. Antegrade bypass from the ascending aorta is an effective alternative for patients who have visceral ischemia.
  
  
  CONCLUSIONS
  A recent study showed that surgical revascularization for chronic mesenteric ischemia (CMI) provides good midterm patency and mortality. Descending aorta or the common iliac artery is usually used as an inflow. In our patient, we decided to use the ascending aorta to provide more absolute flow, and the CHA was used as an outflow because it was easy to expose. To our knowledge, there is no report of using the CHA as a revascularization outflow for patients with CMI.
  
  
  CONCLUSIONS
  In an extensively occluded aorta, the ascending aorta is an excellent alternate inflow for revascularization of the mesenteric artery.
authors.affiliation: Department of Surgery, Division of Vascular Surgery, The Jikei University Kashiwa Hospital, Chiba, Japan. Electronic address: yummmm66@gmail.com.
authors.forename: Yuri
authors.initials: Y
authors.lastname: Murakami
authors.affiliation: Department of Surgery, Division of Vascular Surgery, The Jikei University Kashiwa Hospital, Chiba, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Toya
authors.affiliation: Department of Surgery, Division of Vascular Surgery, The Jikei University Kashiwa Hospital, Chiba, Japan.
authors.forename: Soichiro
authors.initials: S
authors.lastname: Fukushima
authors.affiliation: Department of Surgery, Division of Vascular Surgery, The Jikei University Kashiwa Hospital, Chiba, Japan.
authors.forename: Eisaku
authors.initials: E
authors.lastname: Ito
authors.affiliation: Department of Surgery, The Jikei University Kashiwa Hospital, Chiba, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Akiba
authors.affiliation: Department of Surgery, Division of Vascular Surgery, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Ohki
keywords: Antegrade bypass; Ascending aorta; Chronic mesenteric ischemia; Common hepatic artery