A Novel Technique to Arrange Retrograde Visceral Bypass Grafts used in Hybrid Therapy for Thoracoabdominal Aortic Aneurysms

Schematic presentation of retrograde visceral bypass grafting with medial rotation of the pancreas and spleen. Note that the cranial portion of the descending colon is partly mobilized as well; however, the area of dissection is very limited to obtain a good surgical view of the roots of CA (asterisk) and SMA (arrow). L: Liver, S: Spleen, P: Pancreas, Des. Co: Descending colon, Rt K: Right kidney, Lt K: Left kidney, and #: graft to left RA.

Intraoperative image (a) and postoperative CT scan (b) of a representative case. Note that the length of the grafts to the CA (asterisk) and SMA (arrow) is slightly redundant, and smooth curved configurations of the grafts were meticulously created. #: graft to left RA.