Xavier Berard Profile picture
May 17, 2022 8 tweets 3 min read Read on X
1/8 Aortic graft enteric fistula & chronic occlusion of the SMA, A mini thread to explain our strategy in this high-risk scenario. #aortaEd
2/8 Early seventies patient, fever & weight loss w/ history of aortobifemoral graft done 9 years ago. CTA revealed duodenal fistula on the proximal aortic graft anastomosis
3/8 Detailed analysis of the CTA showed long occlusion of the SMA, it is highly likely that IMA would be lost during the redo surgery
4/8 In this setting, starting with antegrade SMA GSV bypass revascularization thanks to short lateral aortic cross clamping was our choice. After eversion of the first 2 cm of the SMA, inverted GSV was interposed
5/8 Distal anastomosis was done on endarteriectomized portion of distal SMA. Clamp release showed nice peristaltic waves
6/8 during the following steps: duodenal repair, infected graft total retrieval (under infrarenal cross clamp) and in situ repair w/ omentoplasty, the bypass perfused right colon & small bowel
7/8 The in situ repair was done with an already made bovine bifurcated graft (BioIntegral Surgical), as expect IMA was sacrificed. The abdomen was closed with Abthera V.A.C. & 2nd look was planned at 2 days to reassess bowel viability
8/8 during 2nd look L colectomy w/ colostomy was done, the remaining bowel was viable, the abdomen was closed. Microbiological Analysis revealed fungi and gram-negative strains, antimicrobial treatment was adapted accordingly for the following weeks period pubmed.ncbi.nlm.nih.gov/34507894/

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More from @XavierBerardMD

May 4
1- IVC iliac bifurcation and right iliac artery sarcoma.
An illustrated technical note mini thread
#oncovascular #vascsurg

Image
Image
2- We identified a potential risk of R ureter entrapment in the tumor, Pigtail catheter was placed preoperatively and patient informed of potential R nephrectomy
3- The approach was a midline laparotomy, we used a Thompson OneFrame retractor with an extension side bar to extend control in the right iliac fossa Image
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