Retrograde aortomesenteric bypass with tunneling behind the left renal pedicle

This report describes a new technique for revascularization of the superior mesenteric artery (SMA) which creates a retrograde bypass tunneled behind the left renal pedicle. The procedure can be performed by the left retroper itoneal or transperitoneal route, alone or in association with reconstructi on of the infrarenal aorta. Proximal anastomosis is retrograde on the left side of the infrarenal aorta or aortic prosthesis. The course of the bypass runs first in the back and top of the retrorenal dissection plane, then lo ops behind and over the left renal pedicle, and finally turns downward and forward to the SMA. Distal anastomosis can be made either end-to-end or end -to-side. This large, loop-shaped course not only reduces the risk of kinki ng but also gives the bypass enough length to adapt to movements of the SMA . This technique has been performed in association with reconstruction of t he infrarenal aorta in three patients. Postoperative control using Doppler ultrasound, arteriography, and helical CT scan showed no kinking or other a bnormality. One patient died a month after the procedure from myocardial in farction. Follow-up Doppler ultrasound in the two surviving patients showed bypass patency with no stenosis at 19 and 30 months.