Complex abdominal and thoracoabdominal aortic aneurysm reconstruction.

Complex reconstructions of the abdominal aorta are required for aneurysms that require visceral or splanchnic revascularization, when the aorta is inflammatory or infected, when a fistula to the vena cava or bowel is present, and when the aneurysm involves the juxtarenal, pararenal segments, or the full length of the abdominal aorta. The technique for full-length abdominal and thoracoabdominal aortic reconstructions has been modified to separate the visceral and spinal cord revascularization from the body of the main graft. The visceral, renal, and intercostal arteries are not directly reimplanted into the aortic graft but rather into sidearm grafts using a patch inclusion technique. The reconstruction commences distally by anastomosing the main graft to the aortic bifurcation or to the iliac arteries as appropriate. The main graft is then anastomosed to the proximal aorta after which the aortic clamps are released to perfuse the lower limbs. The intercostal arteries are reimplanted into a posterior sidearm graft followed by visceral and renal artery reimplantation into an anterior sidearm graft. This technique reimplantation into an anterior sidearm graft. This technique reduces the period of left ventricular strain to the time taken to complete the upper aortic anastomosis. It also allows separate control of the visceral and intercostal implantations should bleeding occur, without the necessity to reclamp the main body of the graft.