J.Jpn. Surg. Soc.. 80(9): 841-847, 1979

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Original article

THROMBOTIC OCCLUSION OF THE ABDOMINAL AORTA ASSOCIATED WITH STENOTIC LESIONS OF THE BILATERAL RENAL ARTERIES AND SUPERIOR MESENTERIC ARTERY

A 63 year-old male had had progressive bilateral intermittent claudication of the lower extremities for two years prior to the admission. Almost all of the renal function studies showed moderate to severe dysfunction. Transbrachial aortogram revealed total occlusion of the infrarenal abdominal aorta, moderate stenoses of the bilateral renal arteries and subtotal occlusion of the superior mesenteric artery.
Midabdominal incision was employed for exploration. Longitudinal aortic incision was made at the level of the renal arteries under proximal aortic clamping and thromboendarterectomy for the occluded aorta was completed within eleven minutes of renal ischemic time. Then infrarenal aortobilateral femoral grafting was done utilizing knitted Dacron bifurcated prosthesis. The superior mesenteric artery was thromboendarterectomized under partial occlusion of the aorta, and the inferior mesenteric artery was reimplanted to the wall of the Dacron graft. The patient has been doing well for two years after the surgery.
Usually it is well known that these patients with multiple occlusive lesion show grave clinical course and are rapidly compromised occasionally. Prompt surgical treatment for this type of abdominal occlusion with renal and visceral arterial disease is mandatory. Special consideration for the surgical technique to shorten the organ ischemic time, especially to the kidney, during the reconstruction was emphasized. Clinical entity for this type of advanced abdominal aortic occlusive disease was discussed.

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