PMC4941110_01
Pre operative 3D contrast-enhaced CT angiography: lateral view of aorta and origin of visceral vessels, showing preocclusive celiac trunk stenosis and occlusion of the origin and initial 2 cm of the SMA (A). Pre operative contrast-enhaced CT angiography: lateral view of the origin of the celiac trunk (B); cross view of the origin of the celiac trunk (C); lateral view of the origin of the SMA (D); cross view of the origin of the SMA (E).
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An abdominal and pelvic CT angiography (CTA) showed diffuse aortic atheromatosis with extensive aortoiliac calcifications, preocclusive celiac trunk stenosis with distal vessels patent, a 2 cm occlusion from the origin of the superior mesenteric artery (SMA), occlusion of the inferior mesenteric artery, left common iliac artery stenosis and occlusion of the right superficial femoral artery. (Fig. 1).
Aortic revascularization using Dacron grafts showing the supraceliac to bifemoral bypass and retrograde hepatic and superior mesenteric bypasses from the aortobifemoral graft (A). Post operative 3D contrast-enhaced CT angiography showing good patency results (B).
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Visceral revascularization was achieved by retrograde bypasses from the aorto-bifemoral graft to the SMA and to the common hepatic artery (using 8 mm Dacron grafts). (Fig. 2A) After declamping, an area of bowel infarction was recognized in the ileum, requiring a 25 cm small bowel resection and intestinal continuity ensured through mechanical latero-lateral enteric anastomosis. (Fig. 3). The post-operative CT angiography showed good patency results with no surgical complications (Fig. 2B).
Area of bowel infarction in the ileum (A) and (B). Post resection mechanical latero-lateral anastomosis (C).
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Visceral revascularization was achieved by retrograde bypasses from the aorto-bifemoral graft to the SMA and to the common hepatic artery (using 8 mm Dacron grafts). (Fig. 2A) After declamping, an area of bowel infarction was recognized in the ileum, requiring a 25 cm small bowel resection and intestinal continuity ensured through mechanical latero-lateral enteric anastomosis. (Fig. 3).