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Ascending aorta-common hepatic artery bypass for mesenteric revascularization
Yuri Murakami1, Naoki Toya1, Soichiro Fukushima1
1Department of Surgery, Division of Vascular Surgery, The Jikei University Kashiwa Hospital, Chiba, Japan.
Insights
This case study demonstrates an effective antegrade bypass from the ascending aorta to the common hepatic artery for treating extensive aortic occlusion and visceral ischemia. This approach offers a viable alternative for complex aortic disease management.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Gastroenterology
Background:
- Chronic aortic occlusion typically affects the infrarenal aorta.
- This case presents a rare suprarenal aortic occlusion involving the superior mesenteric artery and celiac artery.
Purpose of the Study:
- To describe a novel surgical approach for extensive aortic occlusion.
- To evaluate the efficacy of an antegrade bypass from the ascending aorta to the common hepatic artery.
Main Methods:
- A 59-year-old patient with uremia and anorexia underwent CT, revealing extensive thoracoabdominal aortic occlusion.
- An antegrade bypass was performed from the ascending aorta to the common hepatic artery.
Main Results:
- The patient experienced an uneventful recovery and postoperative course.
- Ascending aorta to common hepatic artery bypass proved effective for visceral revascularization.
Conclusions:
- Ascending aorta serves as an excellent inflow source for mesenteric artery revascularization in extensively occluded aortas.
- Common hepatic artery is a feasible outflow for chronic mesenteric ischemia (CMI) revascularization.
Introduction:
Chronic aortic occlusion usually occurs from the infrarenal branch to the terminal aorta. We report the case of a patient with an occlusion that began at the suprarenal artery, and there was also occlusion of the superior mesenteric artery and extreme stenosis of the celiac artery. Antegrade bypass from the ascending aorta to the common hepatic artery was performed.
Presentation Of Case:
A 59-year-old patient presented to our hospital with uremia due to acute anuric renal failure and anorexia. CT revealed long-segment occlusion of the thoracoabdominal aorta including the superior mesenteric artery and bilateral renal arteries. Additionally, there was high-grade stenosis in the celiac artery. We treated the patient using an antegrade bypass from the ascending aorta to the common hepatic artery. His recovery and postoperative course were uneventful. Antegrade bypass from the ascending aorta is an effective alternative for patients who have visceral ischemia.
Discussion:
A recent study showed that surgical revascularization for chronic mesenteric ischemia (CMI) provides good midterm patency and mortality. Descending aorta or the common iliac artery is usually used as an inflow. In our patient, we decided to use the ascending aorta to provide more absolute flow, and the CHA was used as an outflow because it was easy to expose. To our knowledge, there is no report of using the CHA as a revascularization outflow for patients with CMI.
Conclusion:
In an extensively occluded aorta, the ascending aorta is an excellent alternate inflow for revascularization of the mesenteric artery.
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