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Title
1. Introduction
2. Positioning
3. Posterolateral Thoracotomy
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a. Skin Marking
b. Skin Incision
c. Divide Overlying Musculature
d. Mark 5th Rib
e. Divide Costal Margin
f. 6th Rib Osteotomy
g. Divide Diaphragm with GIA Stapler
4. Left Medial Visceral Rotation
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a. Mobilize Left Kidney
b. Further Division of Diaphragm
c. Shingle Rib
d.Expose L. Renal Artery and Vein
5. Mobilization of Infrarenal Aorta
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a. Dissect SM, Celiac, and L. Renal Arteries
b. Ligate and Divide Branches of Celiac
6. Atrio-Femoral Bypass
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a. Identify Sequential Clamp Sites
b. Mobilize L. Pulmonary Vein and LIgament
c. L. Inf. Pulmonary Vein Purse String
d. Dissect L. Femoral Artery
e. L. Femoral Artery Purse String
f. Cannulate L. Inf. Pulmonary Vein
g. Dilate and Cannulate L. Femoral Artery
7. Prox. Descending Aortic Anastomosis
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a. Clamp Proximal Aorta
b. Open Aorta
c. Anastomose Graft
d. Check Anastomosis for Leaks
e. Revise as Needed
8. Aortic Exposure
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a. Clamp Middle Descending Aorta
b. Divide Aorta Longitudinally
c. Ligate Bleeding Vessels in Lumen
d. Continue Sequential Clamping Distally
e. Measure Graft Length
9. Visceral Ischemia Time
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a. Ligate Celiac Artery
b. Clamp Infrarenal Aorta
c. Quickly Divide Aorta
d. Transect Aorta Below R. Renal Artery
e. Control Bleeding Vessels
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Thoracoabdominal Aortic Aneurysm Repair - Part 1
Andrew Del Re
1
;
Jahan Mohebali, MD, MPH
2
;
Virendra I. Patel, MD, MPH
2
1
The Warren Alpert Medical School of Brown University
2
Massachusetts General Hospital
Tags:
General Surgery
Vascular Surgery
Main Text
Procedure Outline
Transcript
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Authors
Andrew Del Re
Jahan Mohebali, MD, MPH
Virendra I. Patel, MD, MPH
Filmed At:
Massachusetts General Hospital
Article Information
Publication Date
N/A
Article ID
109A
Production ID
0109.1
Volume
N/A
Issue
109A
DOI
https://doi.org/10.24296/jomi/109A