Drawings illustrating an extent II repair of a thoracoabdominal aortic aneurysm (A) that extends from the left subclavian artery to the aortoiliac bifurcation.

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SURGERY of AORTIC ANEURYSMS

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Presentation transcript:

Drawings illustrating an extent II repair of a thoracoabdominal aortic aneurysm (A) that extends from the left subclavian artery to the aortoiliac bifurcation. (B) The patient is positioned, a thoracoabdominal incision is performed, and medial visceral rotation exposes the aorta. (C) During the repair, a left heart bypass circuit provides distal aortic perfusion, and a cold renal delivery system provides renal hypothermia. The proximal portion of the aneurysm is isolated between the clamps placed on the aortic arch (between the left common carotid and left subclavian arteries), and the mid-descending thoracic aorta. The isolated segment of aorta is opened longitudinally and divided circumferentially a few centimeters beyond the proximal clamp. (D) Patent intercostal arteries in this region are oversewn, and the proximal anastomosis is performed with continuous polypropylene suture. (E) Left heart bypass is stopped, and the remainder of the aneurysm is opened longitudinally. Balloon perfusion catheters are inserted into the celiac and superior mesenteric arteries to deliver selective visceral perfusion from the left heart bypass circuit, and into the renal arteries to intermittently deliver cold crystalloid. Patent lower intercostal arteries are reattached to an opening in the graft. (F) The aortic clamp is repositioned to restore intercostal perfusion. The celiac axis, superior mesenteric, and right renal arteries are reattached to an opening in the side of the graft. (G) The aortic clamp is repositioned to restore visceral and right renal perfusion. The distal anastomosis is performed with continuous polypropylene suture at the level of the aortic bifurcation. (H) The mobilized left renal artery is reattached. (I) The completed extent II thoracoabdominal aortic aneurysm repair is shown. (Printed with permission from Baylor College of Medicine). Source: Descending and Thoracoabdominal Aortic Aneurysms, Cardiac Surgery in the Adult, 5e Citation: Cohn LH, Adams DH. Cardiac Surgery in the Adult, 5e; 2017 Available at: http://accesscardiology.mhmedical.com/DownloadImage.aspx?image=/data/books/2157/cardsurg5_ch49_f007g-1.png&sec=164305313&BookID=2157&ChapterSecID=164305253&imagename= Accessed: January 24, 2018 Copyright © 2018 McGraw-Hill Education. All rights reserved