Graft reconstruction to treat disease of the abdominal aorta in patients with colostomies, ileostomies, and abdominal wall urinary stomata Ralph W. DeNatale,

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Presentation transcript:

Graft reconstruction to treat disease of the abdominal aorta in patients with colostomies, ileostomies, and abdominal wall urinary stomata Ralph W. DeNatale, M.D., E.Stanley Crawford, M.D., Hazim J. Safi, M.D., Joseph S. Coselli, M.D. Journal of Vascular Surgery Volume 6, Issue 3, Pages 240-247 (September 1987) DOI: 10.1016/0741-5214(87)90035-8 Copyright © 1987 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 1 Drawings show position of patient and location of incision used in treatment of thoracoabdominal aortic aneurysms and infrarenal abdominal aortic aneurysms that were approached retroperitoneally. Journal of Vascular Surgery 1987 6, 240-247DOI: (10.1016/0741-5214(87)90035-8) Copyright © 1987 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 2 Drawings show method of thoracoabdominal aortic replacement of aneurysm in patients with sigmoid colostomies. A, The descending thoracic and upper abdominal aorta is replaced and the visceral arteries are reattached above the transverse colon. B, The transverse colon is then retracted upward, the infrarenal abdominal aorta exposed, and then replaced by the distal end of graft. Journal of Vascular Surgery 1987 6, 240-247DOI: (10.1016/0741-5214(87)90035-8) Copyright © 1987 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 3 Graft replacement of abdominal aortic aneurysm and preservation of residual colon circulation in a patient who had first abdominoperineal resection of rectum for cancer and later right and hepatic flexure resection for a second cancer. A, Drawing made before operation shows location and extent of aneurysm and blood supply of residual colon. B, Drawing made of operation shows location and aortic graft and reattachment of inferior mesenteric artery. Journal of Vascular Surgery 1987 6, 240-247DOI: (10.1016/0741-5214(87)90035-8) Copyright © 1987 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 4 Graft replacement for abdominal aortic aneurysm in patient who had both right-sided ileal loop urinary diversion and left-sided end sigmoid colostomy. A, Drawing made before operation shows location of ureters and ileum and extent of aneurysm. B, Drawing shows method of treatment. Journal of Vascular Surgery 1987 6, 240-247DOI: (10.1016/0741-5214(87)90035-8) Copyright © 1987 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 5 Method of graft replacement of infrarenal aortic aneurysm with the transperitoneal retroperitoneal approach. With the use of the incision shown in Fig. 1, the chest is entered through the bed of the ninth or tenth rib to expose the upper surface of the diaphragm and lower thoracic aorta. The peritoneum is either stripped from the undersurface of diaphragm and abdominal wall (completely retroperitoneal) or the peritoneum is entered anteriorly and then the retroperitoneum is entered lateral to the descending colon. Regardless, the aorta is exposed laterally and behind by retracting the viscera upward and to the right. The aorta is clamped above the diaphragm, the aneurysm opened, the proximal segment flushed, and the graft is clamped below the renal arteries. Visceral arterial blood flow is restored by removal of the lower thoracic aortic clamp while the distal anastomosis is being made. Journal of Vascular Surgery 1987 6, 240-247DOI: (10.1016/0741-5214(87)90035-8) Copyright © 1987 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 6 Proximal endarterectomy of aorta, superior mesenteric, and right renal artery and aorto—bilateral common femoral artery bypass graft in treatment of patient with total aortic obstruction occurring after left nephrectomy, total cystectomy, and right-sided ileal loop urinary diversion. A, Drawing shows extent of occlusive disease and position of ileal loop urinary diversion procedure. B, Drawing of treatment used in this case. Journal of Vascular Surgery 1987 6, 240-247DOI: (10.1016/0741-5214(87)90035-8) Copyright © 1987 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions