Reverse C-Graft Configuration for Retrograde Aorta Celiac and Superior Mesenteric Bypass Via the Left Retroperitoneal Approach

Abstract

The authors report a case of simultaneous elective aortic aneurysm repair and visceral revascularization via the left retroperitoneal approach in a 75-year-old woman. The patient presented with a 5.8 cm infrarenal aneurysm by computed tomography scan. A preoperative arteriogram demonstrated an infrarenal abdominal aortic aneurysm extending to the bifurcation and a left common iliac artery aneurysm. Lateral views showed high-grade stenosis of the celiac artery origin and complete occlusion of the proximal superior mesenteric artery (SMA) with distal reconstitution. The infrarenal aneurysm was repaired via the extended left retroperitoneal approach with an exclusion bypass graft to the iliac arteries. The proximal celiac and superior mesenteric arteries were approached anterior to the left kidney. An 8 mm side arm polytetrafluoroethylene (PTFE) graft was anastomosed to the aortic graft and was brought retrograde posterior to the hilum of the kidney in a reverse C-configuration to the proximal celiac artery where an end-to-side anastomosis was performed. A short 6 mm side arm PTFE from the celiac graft was used to bypass the proximal SMA. The postoperative course was uneventful and the patient was discharged in 5 days. A repeat arteriogram demonstrated patent grafts without kinking.