Thoracoabdominal Aortic Aneurysm Repair - Part 1

1. Introduction

2. Positioning

3. Posterolateral Thoracotomy

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

4. Left Medial Visceral Rotation

1. Mobilize Left Kidney
2. Further Division of Diaphragm
3. Shingle Rib
4. Expose Left Renal Artery and Vein

5. Mobilization of Infrarenal Aorta

1. Dissect SM, Celiac, and Left Renal Arteries
2. Ligate and Divide Branches from Celiac Artery

6. Atrio Femoral Bypass

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

7. Proximal Descending Aortic Anastomosis

1. Clamp Proximal Aorta
2. Open Aorta
3. Anastomose Graft
4. Check Anastomosis for Leaks
5. Revise as Needed

8. Aortic Exposure

1. Clamp Middle Descending Aorta
2. Divide Aorta Longitudinally
3. Ligate Bleeding Vessels in Lumen
4. Continue Sequential Clamping Distally
5. Measure Graft Length

9. Visceral Ischemia Time

1. Ligate Celiac Artery
2. Clamp Infrarenal Aorta
3. Quickly Divide Aorta
4. Transect Aorta Below Right Renal Artery
5. Control Bleeding Vessels