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Coral Reef Aorta: An Endangered Species
Charles C. Leithead, Zdenek Novak, William D Jordan, Jr.
University of Alabama at Birmingham, Birmingham, AL

Mesenteric and renal artery occlusive disease with bilateral lower extremity ischemia is a rare condition that we recently encountered at our institution. 69 year old white female who had prior aortobiiliac endarterectomy in 1997 at an outside institution presented to our center with complete aortic occlusion which caused severe lower extremity ischemia with short distance claudication. She also had mesenteric occlusive disease with weight loss and renovascular hypertension. The CT scan showed extensive aortic plaque with four vessel occlusive disease and a small left kidney.
METHODS:After appropriate operative preparation, we performed a transaortic mesenteric and renal endarterectomy with thoracic aorta to bilateral external iliac artery bypass.
We exposed the lower thoracic and abdominal aorta by a retroperitoneal approach via the 8thintercostal space. Appropriate backbleeding was observed from the mesenteric and right renal artery with a total ischemic time of 35 minutes. A 16 x 8 bifurcated Dacron graft was sewn over the arteriotomy noting perfusion of the celiac, SMA and right renal artery. We then created an end-to-side anastomosis on the anterior wall of the left external iliac artery. The more anterior limb of the graft traversed from the retroperitoneum to a preperitoneal plane to the right external iliac artery. The main body was tunneled behind the left kidney in a retroperitoneal plane.
After appropriate convolescence, she was discharged on postoperative day fifteen with palpable pedal pulses, normal gastrointestinal function and normal blood pressure without medications.

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