Novel visceral reconstruction for paravisceral aortic aneurysm complicated with aortoiliac occlusion

Visceral ischemia is a serious factor in the postoperative morbidity and mortality of suprarenal aortic reconstruction. We report a case of a patient who underwent surgical repair for a paravisceral aortic aneurysm complicated with aortoiliac occlusion, using a novel visceral reconstruction. Prior to proximal anastomosis of the aorta, we reconstructed visceral arteries by bypass grafting to the superior mesenteric artery and right renal artery (RA), using a straight 12-mm prosthetic graft originating from the intact descending aorta. During the visceral reconstruction, selective cold crystalloid perfusion of the RA was performed. We then underwent the proximal anastomosis of the aorta just below the celiac trunk using a Y-shaped prosthetic graft 18×10 mm in diameter, in keeping the adequate visceral perfusion. Finally, a femoro-femoral bypass was performed with an 8-mm Gore-Tex Vascular Graft, and the left limb of the Y-shaped graft was sewn onto the side of this prosthetic graft. Postoperative computed tomography (CT) identified the successful repair of the aneurysm without any complications. Our novel visceral reconstruction could allow the surgeon to provide a physiological perfusion of visceral organs and prevent the potential visceral ischemia, during suprarenal aortic reconstruction.