Novel Visceral-Anastomosis-First Approach in Open Repair of a Ruptured Type 2 Thoracoabdominal Aortic Aneurysm: Causes behind a Mortal Outcome

Figure 2

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.