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CASE REPORT
Staged retroperitoneal mesenteric revascularisation and aortobifemoral bypass after endovascular rescue for acute mesenteric ischaemia
  1. Shepard Peir Johnson1,
  2. Melani Lighter1,
  3. Harry Linne Anderson III1,
  4. Abdulhameed Aziz2
  1. 1 Department of Surgery, St Joseph Mercy Ann Arbor, Ann Arbor, Michigan, USA
  2. 2 Department of Endovascular and Vascular Surgery, St Joseph Mercy Ann Arbor, Ann Arbor, Michigan, USA
  1. Correspondence to Dr Harry Linne Anderson, III, harry.anderson{at}stjoeshealth.org

Summary

Visceral artery revascularisation through a retroperitoneal approach provides an infrequent yet viable, alternative means of managing mesenteric ischaemia in patients with previous abdominal operations. We present a unique case implementing this surgical approach in a 55-year-old man in which we performed a retroperitoneal aortobifemoral bypass with concomitant retrograde jump graft from the aortic prosthesis to the superior mesenteric artery (SMA) for bilateral lower extremity rest pain and chronic mesenteric ischaemia. Three months previously, the patient had presented with acute mesenteric ischaemia and colonic perforation. He underwent emergent celiac artery stenting followed by an exploratory laparotomy with total abdominal colectomy and diverting loop ileostomy. Given the patient's hostile abdomen, a retroperitoneal approach to SMA revascularisation was elected over a transabdominal approach during concomitant lower extremity revascularisation for critical limb ischaemia. We achieved an excellent technical result with resolution of limb ischaemia and abdominal symptoms.

  • vascular surgery
  • general surgery
  • interventional radiology

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Footnotes

  • Contributors SPJ was the primary author and lead writer for this case report. ML provided assistance in writing the manuscript and performing background research on the subject matter. HLA was the corresponding author and provided manuscript editing, background research and oversight of the case report. AA provided specialty knowledge on the subject matter, reviewed the manuscript contents for accuracy, provided the final manuscript edits and served as the primary investigator.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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