Clinical Scenarios In Vascular Surgery by Upchurch Gilbert R. & Henke Peter K

Author:Upchurch, Gilbert R. & Henke, Peter K.
Language: eng
Format: epub
Publisher: LWW
Published: 2015-02-23T16:00:00+00:00

Aortoaortic Bypass

Aortoaortic bypass is favored for those patients whose coarctation precludes patch aortoplasty secondary to diminutive caliber and in certain complex cases that require concomitant renal and splanchnic reconstruction. The PTFE conduit should be sized at least 60% to 70% the size of the adult aorta to prevent it from becoming an energy-consuming constriction as the aorta matures. This translates into an 8- to 12-mm graft in young children, a 12- to 16-mm graft in early adolescents, and a 14- to 20-mm graft in late adolescents and adults. Graft length should be constructed slightly more redundant in younger children to allow for stretch with axial growth; however, there is minimal axial growth from the diaphragm to the pelvis after 9 to 10 years of age.

Following the guidelines for exposure and vascular control outlined above, the respective aortotomies should be created on the anterolateral aorta sharply and widened with an aortic punch. Thoracoabdominal bypass grafts are typically tunneled posterior to the left kidney. The graft should be beveled accordingly prior to constructing each respective end-to-side anastomosis with Teflon or polypropylene suture. Restoration of flow, hemostasis, and closure should proceed as described above.

Rarely, interposition aortic grafts may be considered to treat short-segment coarctations in the absence of branch vessel involvement. This often permits a more limited exposure. The technical components vary only in that the respective anastomoses are constructed in an end-to-end fashion.

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