PMC3588210_01
Computed tomography sections at the level of the descending aorta (upper panel), at the level of the left renal ostium (middle panel), and at the level of the infrarenal aorta (lower panel).
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fig1
Aneurysm diameter was 8.7 cm in the mid-descending part and 5.5 cm at the level of the renal arteries (Figure 1).
The presutured vascular prosthesis construct (shaded grey) consists of a temporary axillobifemoral bypass with a branch to the permanent aortic prosthesis. The drawing depicts an opened abdominal part of the aneurysm. Two Foley catheters are used for iliac occlusion. The left kidney is perfusion-cooled, and occlusion catheters occlude the right renal (shown) and visceral arteries (not shown). Holes in the middle part of the aortic prosthesis, placed after measurements on preoperative computed tomography images, are ready to be anastomosed to the visceral and right renal ostia. After completion of these anastomoses, the ligature on the connection between the temporary bypass and the aortic prosthesis is removed, and the right kidney and intestines are perfused via the middle part of the aortic prosthesis which is isolated using temporary ligatures (not shown), while a side branch with another temporary ligature is anastomosed to the left renal ostium. Finally, the distal and proximal ends of the aortic prosthesis are anastomosed to the aortic bifurcation and to the aorta just distally to the left subclavian artery, respectively.
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fig2
With the patient supine, a presutured vascular prosthesis construct (Figure 2), doubly wrapped in tubular drape, was anastomosed to the right axillary and both femoral arteries after heparinization (5000 IU) by two surgeons working simultaneously.