[Transdiaphragmatic approach to the supraceliac aorta. Surgical anatomy and operative technic]

The surgical anatomy and the practical modalities of the trans-peritoneal-diaphragmatic approach of the low thoracic aorta have been studied on the basis of 40 consecutive dissections. The trans-diaphragmatic approach of the supra-celiac aorta can be performed: either through a restrictive way, by dissociation of the muscular fibers of the posterior angle of the oesophagal hiatus, thus allowing the access to a mean 30 mm long part of supra-celiac aorta, large enough to perform a complete aortic clamping; either through an extensive way, by medial sagittal section, in front of the aorta of the muscular fibers of the posterior angle of the oesophagal hiatus and of the arcate ligament, thus permetting this exposure of a longer aortic part (60 mm on a average) and the realization of more important aortic procedures. These may be performed with a lateral aortic clamp, on account of the large diameter of the aorta at this level (30 mm on an average).