PMC6033210_01
(A) Computed tomography angiography reconstruction showing aberrant right hepatic and thrombosed superior mesenteric artery aneurysm. (B) Beaded appearance of both renal arteries. (C) Mid right internal carotid artery 6 mm aneurysm.
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The anatomy was complicated by an aberrant right hepatic artery arising from the SMA origin immediately proximal to the aneurysm and was the dominant supply to the liver and the gastroduodenal artery (Fig. 1). The appearance of both renal arteries demonstrated a beaded appearance with sparing of the ostia diagnostic of FMD (Fig. 1). A CT angiogram of the carotid and cerebral arteries showed a 6 mm aneurysm of the mid right internal carotid artery with the typical of the appearances of FMD (Fig. 1).
(A) Medial visceral rotation anterior to left kidney, vein graft anastomosis to the origin of the superior mesenteric artery. (B) Distal anastomosis through the infra-colic compartment.
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Retroperitoneal exposure required a rooftop incision with left sub-costal extension, and medial visceral rotation to access the proximal and distal aspects of the SMA aneurysm (Fig. 2). The graft was tunnelled anatomically through the root of mesentery (Figure 2, Figure 3).
Post-reconstruction computed tomography angiogram showing anatomical bypass graft.
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The graft was tunnelled anatomically through the root of mesentery (Figure 2, Figure 3). A CTA demonstrated technical success (Fig. 3).