REVERSE C-GRAFT CONFIGURATION FOR RETROGRADE AORTA CELIAC AND SUPERIOR MESENTERIC BYPASS VIA THE LEFT RETROPERITONEAL APPROACH - A CASE-REPORT

The authors report a case of simultaneous elective aortic aneurysm rep air and visceral revascularization via the left retroperitoneal approa ch in a 75-year-old woman. The patient presented with a 5.8 cm infrare nal aneurysm by computed tomography scan. A preoperative arteriogram d emonstrated an infrarenal abdominal aortic aneurysm extending to the b ifurcation and a left common iliac artery aneurysm. Lateral views show ed high-grade stenosis of the celiac artery origin and complete occlus ion of the proximal superior mesenteric artery (SMA) with distal recon stitution. The infrarenal aneurysm was repaired via the extended left retroperitoneal approach with an exclusion bypass graft to the iliac a rteries. The proximal celiac and superior mesenteric arteries were app roached anterior to the left kidney. An 8 mm side arm polytetrafluoroe thylene (PTFE) graft was anastomosed to the aortic graft and was broug ht retrograde posterior to the hilum of the kidney in a reverse C-conf iguration to the proximal celiac artery where an end-to-side anastomos is was performed. A short 6 mm side arm PTFE from the celiac graft was used to bypass the proximal SMA. The postoperative course was unevent ful and the patient was discharged in 5 days. A repeat arteriogram dem onstrated patent grafts without kinking.