Axillomesenteric bypass: an unusual solution to a difficult problem

A 49-year-old woman presented with acute anuric renal failure and severe hypertension. Imaging revealed occlusion of the distal thoracic and abdominal aorta. Acute hemodialysis and reduction in blood pressure precipitated an acute exacerbation of previously undiagnosed mesenteric ischemia. Repeated episodes of flash pulmonary edema and a generally parlous clinical condition precluded thoracoabdominal reconstruction. As a result, a left axillomesenteric bypass was performed as a substitute, using a 6-mm externally ringed PTFE graft. She made an uneventful recovery, and her abdominal symptoms resolved swiftly. The patient remains symptom-free 12 months postoperatively. In this rare situation, extra-anatomic bypass provided an unorthodox but less-invasive solution to a difficult surgical problem.