PMC7424169_01
Photographic pictures of the abdominopelvic cavity and thigh showing aortic tree together with the aortobifemoral grafting: (A) Dissection illustrating the abdominal aorta and aortobifemoral implant within the area selected by the yellow box; (B) Higher magnification of the selected area in Fig. 1A. The entire length of the inverted Y-shaped aortobifemoral implant is marked with red asterisks, the blue arrow indicates the single end of the Y sewn on the aorta just below the branching of renal arteries, and the yellow arrows indicate the two split ends of the Y sewn below the blocked areas of the femoral arteries.
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Following dissection of the retro-peritoneum and preparation of the abdominal aorta and its branches, an aortobifemoral arterial bypass implant was found (Fig. 1, Fig. 2). The aortobifemoral arterial bypass implant found in the cadaver was made of synthetic material (most likely polytetrafluoroethyline or Dacron), and it extended between abdominal aorta and femoral arteries (Fig. 1, Fig. 3B).
Photographs of both ends of the Y-shaped aortobifemoral implant: (A) Higher magnification of the single end of the Y-shaped implant (Y) sewn on the aorta (asterisk) just below the branching of renal arteries; (B) Higher magnification of the split end of the Y-shaped aortobifemoral implant (Y) sewn below the blocked area of the left femoral artery (asterisk). Abbreviations: TA, thoracic aorta; AA, abdominal aorta; DIAPH, diaphragm; CT, coeliac trunk/artery; SMA, superior mesenteric artery; RA, renal artery; LK, left kidney; IL, site of the inguinal ligament; LEIA, left external iliac artery; LFA, left femoral artery; LFV, left femoral vein; LGSV, left great saphenous vein.
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The synthetic implant was formed into a Y shape with the single end of the Y was sewn on the aorta just below the branching of renal arteries to create the proximal aortic anastomosis in end-to-side fashion (Figs. 2A and 3 B). The two split ends of the Y were sewn below the blocked areas of the femoral arteries (Figs. 2B ad 3 B).
Schematic drawings of aortobifemoral bypass grafting: (A) Normal aortic tree; (B) Schematic representation of Fig. 1A. End-to-side anastomosis for direct revascularization of the aortoiliac segment creates a bypass for blood to travel around the blocked sections of the diseased areas in the arteries.
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The abdominal aorta runs along the left anterolateral aspect of the lumbar spine, and at approximately the fourth to fifth lumbar vertebrae level the common iliac arteries branch from the aortic bifurcation and extend downward and outward to the groin (Fig. 3). Similar to the aorta, the common iliac arteries also showed calcification (Fig. 3B), whereas, calcification in the walls of abdominal vena cava was not observed. The synthetic implant was formed into a Y shape with the single end of the Y was sewn on the aorta just below the branching of renal arteries to create the proximal aortic anastomosis in end-to-side fashion (Figs. 2A and 3 B). The two split ends of the Y were sewn below the blocked areas of the femoral arteries (Figs. 2B ad 3 B).