PMC5470002_01
An illustration showing large type III Crawford thoracoabdominal aneurysm (TAAA) with extensive infrarenal segment thrombosis and left renal artery occlusion (a). Axial computed tomography angiogram showing the distal thoracic aorta measuring 65 mm (b), celiac artery origin (arrow in (c)), right renal artery stenosis (arrow) and left renal artery occlusion with left renal atrophy (d), and thrombosed infrarenal component of the TAAA (asterisk) measuring 42 mm (e).
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fig1
The celiac, superior mesenteric, and right renal arteries were patent, whereas the origin of the left renal artery was occluded with an atrophic left kidney (Figures 1(a), 1(b), 1(c), and 1(d)) and normal serum creatinine. The infrarenal component of the aneurysm and both common iliac arteries were thrombosed (Figures 1(a) and 1(e)).
Intraoperative exposure showing the aortobifemoral, aorto-right renal, and aorto-celiac/superior mesenteric artery bypass grafts (a). Anastomosis of the graft to the right renal artery (b). Anastomosis of the graft to the superior mesenteric and celiac arteries (c).
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fig2
The first limb of the new graft was anastomosed to the right renal artery in an end-to-side fashion, while the second limb was sutured to the superior mesenteric artery (side-to-side) and the celiac artery (end-to-side), (Figure 2).
Intraoperative angiogram showing the reestablishment of the aortic blood flow through the stent graft with complete exclusion of the aneurysm (a, b, c, and d).
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fig3
TAAA without any endoleak and good flow to all the debranched vessels (Figures 3 and 4).
Normal blood flow in the superior mesenteric artery, celiac trunk (a), and right renal artery (b) is demonstrated on the intraoperative angiogram after retrograde graft revascularization of these vessels.
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fig4
TAAA without any endoleak and good flow to all the debranched vessels (Figures 3 and 4).