[Indications of the trans-diaphragmatic approach to the supra-celiac aorta]

The trans-diaphragmatic approach of the supra-celiac aorta can be performed in two different ways, according to the indications of this approach: The approach through a restrictive way, by simple dissociation of the muscular fibers of the posterior angle of the oesophagal hiatus allows an high and fast aortic clamping, especially helpful when a serious sub-diaphragmatic bleeding is encountered. It can also be used at the time of reintervention on the sub-renal aorta, in case of juxta-renal aortic thrombosis or in case of abdominal aortic aneurysm involving renal arteries. The approach through an extensive way, by saggital section of the muscular fibers of the posterior angle of the oesophagal hiatus and of the arcate ligament increases considerably the length of the exposed aortic segment and allows the implant of a by-pass graft on the lower thoracic aorta; this graft can be used to revascularize the underlying aortic step; it can also be used to shunt a lesion of the thoracic aorta.