The retroperitoneal, left flank approach to the supraceliac aorta for difficult and repeat aortic reconstructions

Joseph L Mills, Roy M. Fujitani, Spence M. Taylor

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Between 1986 and 1990, 11 patients with relative or absolute contraindications to standard infrarenal reconstructions underwent supraceliac aortofemoral bypass. The operation was performed through a left-flank incision extended into the eleventh intercostal space with retroperitoneal and extrapleural dissection. Indications included multiple failed infrarenal reconstructions in four patients, previous removal of infected aortofemoral bypass graft with failure of extra-anatomic bypass in five patients, prior para-aortic lymph node dissection and radiotherapy in one patient, and aortic aneurysmal disease proximal to the renal arteries in one patient. Bypass conduits included either a bifurcated Dacron graft or a tube graft to the left femoral artery with a femorofemoral cross-over graft; concomitant left renal artery reconstruction was performed in three patients. The mean supraceliac cross-clamp time was 24 minutes, and only one patient experienced transient postoperative acute tubular necrosis. There was no operative mortality. The graft limb patency was 95% after mean follow-up extending to 17 months (range: 5 months to 5 years). We conclude that the supraceliac aorta is a useful inflow source for aortofemoral reconstruction in difficult repeat cases. It can be approached easily without thoracotomy and avoids difficult infrarenal aortic dissection in a scarred field. The tunneling is easier than with descending thoracic aorta or ascending aorta inflow sources. In addition, this bypass is likely to be more durable than inflow reconstructions based on the axillary artery.

Original languageEnglish (US)
Pages (from-to)638-642
Number of pages5
JournalAmerican Journal of Surgery
Volume162
Issue number6
DOIs
StatePublished - 1991
Externally publishedYes

Fingerprint

Aorta
Transplants
Renal Artery
Thoracic Aorta
Dissection
Axillary Artery
Retroperitoneal Space
Aortic Diseases
Polyethylene Terephthalates
Thoracotomy
Femoral Artery
Lymph Node Excision
Necrosis
Radiotherapy
Extremities
Mortality

ASJC Scopus subject areas

  • Surgery

Cite this

The retroperitoneal, left flank approach to the supraceliac aorta for difficult and repeat aortic reconstructions. / Mills, Joseph L; Fujitani, Roy M.; Taylor, Spence M.

In: American Journal of Surgery, Vol. 162, No. 6, 1991, p. 638-642.

Research output: Contribution to journalArticle

@article{6f3bcc0da38a4b49959aa234f245f347,
title = "The retroperitoneal, left flank approach to the supraceliac aorta for difficult and repeat aortic reconstructions",
abstract = "Between 1986 and 1990, 11 patients with relative or absolute contraindications to standard infrarenal reconstructions underwent supraceliac aortofemoral bypass. The operation was performed through a left-flank incision extended into the eleventh intercostal space with retroperitoneal and extrapleural dissection. Indications included multiple failed infrarenal reconstructions in four patients, previous removal of infected aortofemoral bypass graft with failure of extra-anatomic bypass in five patients, prior para-aortic lymph node dissection and radiotherapy in one patient, and aortic aneurysmal disease proximal to the renal arteries in one patient. Bypass conduits included either a bifurcated Dacron graft or a tube graft to the left femoral artery with a femorofemoral cross-over graft; concomitant left renal artery reconstruction was performed in three patients. The mean supraceliac cross-clamp time was 24 minutes, and only one patient experienced transient postoperative acute tubular necrosis. There was no operative mortality. The graft limb patency was 95{\%} after mean follow-up extending to 17 months (range: 5 months to 5 years). We conclude that the supraceliac aorta is a useful inflow source for aortofemoral reconstruction in difficult repeat cases. It can be approached easily without thoracotomy and avoids difficult infrarenal aortic dissection in a scarred field. The tunneling is easier than with descending thoracic aorta or ascending aorta inflow sources. In addition, this bypass is likely to be more durable than inflow reconstructions based on the axillary artery.",
author = "Mills, {Joseph L} and Fujitani, {Roy M.} and Taylor, {Spence M.}",
year = "1991",
doi = "10.1016/0002-9610(91)90126-X",
language = "English (US)",
volume = "162",
pages = "638--642",
journal = "American Journal of Surgery",
issn = "0002-9610",
publisher = "Elsevier Inc.",
number = "6",

}

TY - JOUR

T1 - The retroperitoneal, left flank approach to the supraceliac aorta for difficult and repeat aortic reconstructions

AU - Mills, Joseph L

AU - Fujitani, Roy M.

AU - Taylor, Spence M.

PY - 1991

Y1 - 1991

N2 - Between 1986 and 1990, 11 patients with relative or absolute contraindications to standard infrarenal reconstructions underwent supraceliac aortofemoral bypass. The operation was performed through a left-flank incision extended into the eleventh intercostal space with retroperitoneal and extrapleural dissection. Indications included multiple failed infrarenal reconstructions in four patients, previous removal of infected aortofemoral bypass graft with failure of extra-anatomic bypass in five patients, prior para-aortic lymph node dissection and radiotherapy in one patient, and aortic aneurysmal disease proximal to the renal arteries in one patient. Bypass conduits included either a bifurcated Dacron graft or a tube graft to the left femoral artery with a femorofemoral cross-over graft; concomitant left renal artery reconstruction was performed in three patients. The mean supraceliac cross-clamp time was 24 minutes, and only one patient experienced transient postoperative acute tubular necrosis. There was no operative mortality. The graft limb patency was 95% after mean follow-up extending to 17 months (range: 5 months to 5 years). We conclude that the supraceliac aorta is a useful inflow source for aortofemoral reconstruction in difficult repeat cases. It can be approached easily without thoracotomy and avoids difficult infrarenal aortic dissection in a scarred field. The tunneling is easier than with descending thoracic aorta or ascending aorta inflow sources. In addition, this bypass is likely to be more durable than inflow reconstructions based on the axillary artery.

AB - Between 1986 and 1990, 11 patients with relative or absolute contraindications to standard infrarenal reconstructions underwent supraceliac aortofemoral bypass. The operation was performed through a left-flank incision extended into the eleventh intercostal space with retroperitoneal and extrapleural dissection. Indications included multiple failed infrarenal reconstructions in four patients, previous removal of infected aortofemoral bypass graft with failure of extra-anatomic bypass in five patients, prior para-aortic lymph node dissection and radiotherapy in one patient, and aortic aneurysmal disease proximal to the renal arteries in one patient. Bypass conduits included either a bifurcated Dacron graft or a tube graft to the left femoral artery with a femorofemoral cross-over graft; concomitant left renal artery reconstruction was performed in three patients. The mean supraceliac cross-clamp time was 24 minutes, and only one patient experienced transient postoperative acute tubular necrosis. There was no operative mortality. The graft limb patency was 95% after mean follow-up extending to 17 months (range: 5 months to 5 years). We conclude that the supraceliac aorta is a useful inflow source for aortofemoral reconstruction in difficult repeat cases. It can be approached easily without thoracotomy and avoids difficult infrarenal aortic dissection in a scarred field. The tunneling is easier than with descending thoracic aorta or ascending aorta inflow sources. In addition, this bypass is likely to be more durable than inflow reconstructions based on the axillary artery.

UR - http://www.scopus.com/inward/record.url?scp=0026356682&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0026356682&partnerID=8YFLogxK

U2 - 10.1016/0002-9610(91)90126-X

DO - 10.1016/0002-9610(91)90126-X

M3 - Article

C2 - 1670241

AN - SCOPUS:0026356682

VL - 162

SP - 638

EP - 642

JO - American Journal of Surgery

JF - American Journal of Surgery

SN - 0002-9610

IS - 6

ER -