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Transabdominal access to the thoracic aorta for aortofemoral bypass grafting
E A Tovar1, C Del Campo, R E McCoy
1Division of Cardiovascular Surgery, St. Jude Medical Center, Fullerton, California 92635, USA.
Insights
Acute abdominal aortic thrombosis in comatose patients requires direct organ examination. A novel technique accesses the thoracic aorta via the abdomen, avoiding thoracoabdominal incisions for critically ill patients with aortic media calcinosis.
Area of Science:
- Vascular Surgery
- Surgical Techniques
- Critical Care Medicine
Background:
- Acute thrombosis of the abdominal aorta presents a surgical challenge, especially in comatose patients requiring intraabdominal organ assessment.
- Media calcinosis of the infrarenal aorta, often found during laparotomy, contraindicates its use as an inflow source for vascular reconstruction.
- Existing surgical approaches may necessitate extensive incisions, posing risks to critically ill patients.
Observation:
- Direct examination of intraabdominal organs is mandatory in cases of acute abdominal aortic thrombosis.
- Infrarenal aortic media calcinosis limits surgical options for inflow source during laparotomy.
- A modified surgical approach can provide access to the thoracic aorta through an abdominal incision.
Findings:
- A technique for exposing the thoracic aorta through an abdominal approach is described.
- This method bypasses the need for a thoracoabdominal incision.
- It is particularly beneficial for critically ill patients with abdominal aortic thrombosis and infrarenal aortic media calcinosis.
Implications:
- This surgical technique offers a viable alternative for managing complex aortic emergencies in high-risk patients.
- It potentially reduces operative morbidity by avoiding a thoracoabdominal incision.
- The described approach expands the armamentarium for vascular surgeons dealing with challenging aortic pathologies.
Abstract:
When acute thrombosis of the abdominal aorta occurs in a comatose patient, direct examination of the intraabdominal organs becomes mandatory. Once a laparotomy has been performed, media calcinosis of the infrarenal aorta is a contraindication to its use as an inflow source. We describe a technique for exposing the thoracic aorta through the abdomen, which obviates the need for a thoracoabdominal incision in such critically ill patients.