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  • 1. Introduction
  • 2. Positioning
  • 3. Posterolateral Thoracotomy
  • 4. Left Medial Visceral Rotation
  • 5. Mobilization of Infrarenal Aorta
  • 6. Atrio-Femoral Bypass
  • 7. Prox. Descending Aortic Anastomosis
  • 8. Aortic Exposure
  • 9. Visceral Ischemia Time
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Thoracoabdominal Aortic Aneurysm Repair - Part 1

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Andrew Del Re1; Jahan Mohebali, MD, MPH2; Virendra I. Patel, MD, MPH2
1The Warren Alpert Medical School of Brown University
2Massachusetts General Hospital

General SurgeryVascular Surgery
Main TextProcedure OutlineTranscript

Procedure Outline

Table of Contents

  1. 1. Introduction
  2. 2. Positioning
  3. 3. Posterolateral Thoracotomy
  4. 4. Left Medial Visceral Rotation
  5. 5. Mobilization of Infrarenal Aorta
  6. 6. Atrio Femoral Bypass
  7. 7. Proximal Descending Aortic Anastomosis
  8. 8. Aortic Exposure
  9. 9. Visceral Ischemia Time
  1. Skin Marking
  2. Skin Incision
  3. Divide Overlying Musculature
  4. Mark 5th Rib
  5. Divide Costal Margin
  6. 6th Rib Osteotomy
  7. Divide Diaphragm with GIA Stapler
  1. Mobilize Left Kidney
  2. Further Division of Diaphragm
  3. Shingle Rib
  4. Expose Left Renal Artery and Vein
  1. Dissect SM, Celiac, and Left Renal Arteries
  2. Ligate and Divide Branches from Celiac Artery
  1. Identify Sequential Clamp Sites
  2. Mobilize Left Pulmonary Vein and Ligament
  3. Left Inferior Pulmonary Purse String
  4. Dissect Left Femoral Artery
  5. Left Femoral Artery Purse String
  6. Cannulate Left Inferior Pulmonary Vein
  7. Dilate and Cannulate Left Femoral Artery
  1. Clamp Proximal Aorta
  2. Open Aorta
  3. Anastomose Graft
  4. Check Anastomosis for Leaks
  5. Revise as Needed
  1. Clamp Middle Descending Aorta
  2. Divide Aorta Longitudinally
  3. Ligate Bleeding Vessels in Lumen
  4. Continue Sequential Clamping Distally
  5. Measure Graft Length
  1. Ligate Celiac Artery
  2. Clamp Infrarenal Aorta
  3. Quickly Divide Aorta
  4. Transect Aorta Below Right Renal Artery
  5. Control Bleeding Vessels