A. C. Moncure, MD, D. C. Brewster, MD, R. C. Darling, MD, W. M

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Presentation transcript:

Use of the gastroduodenal artery in right renal artery revascularization A.C. Moncure, MD, D.C. Brewster, MD, R.C. Darling, MD, W.M. Abbott, MD, R.P. Cambria, MD Journal of Vascular Surgery Volume 8, Issue 2, Pages 154-159 (August 1988) DOI: 10.1016/0741-5214(88)90403-X Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 A, Right subcostal incision extends across the midline laterally to the tip of the right eleventh rib. B, Hepatoduodenal ligament overlying the porta hepatis in incised. C, Common hepatic artery and origin of gastroduodenal artery is encircled. Journal of Vascular Surgery 1988 8, 154-159DOI: (10.1016/0741-5214(88)90403-X) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Kocher's maneuver elevates duodenum, allowing dissection of the gastroduodenal artery to its bifurcation, or until the pancreas is encountered. Journal of Vascular Surgery 1988 8, 154-159DOI: (10.1016/0741-5214(88)90403-X) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 After identification of the inferior vena cava posterior to the duodenum, the right renal vein is identified, and the neighboring renal artery is encircled. The encircled gastroduodenal artery is gently occluded at its origin, divided at its bifurcation, and ligated distally. Journal of Vascular Surgery 1988 8, 154-159DOI: (10.1016/0741-5214(88)90403-X) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 A No. 3 Fogarty embolectomy catheter is passed into the hepatic artery, inflated, and slowly brought back through the gastroduodenal artery. Journal of Vascular Surgery 1988 8, 154-159DOI: (10.1016/0741-5214(88)90403-X) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 The renal artery after distal occlusion, division, and proximal ligation is probed with coronary dilators, and anastomosed end to end to the gastroduodenal artery. Journal of Vascular Surgery 1988 8, 154-159DOI: (10.1016/0741-5214(88)90403-X) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 Postoperative arteriogram shows the common hepatic artery (open arrow) and gastroduodenal—right renal artery end-to-end anastomosis (closed arrow). Journal of Vascular Surgery 1988 8, 154-159DOI: (10.1016/0741-5214(88)90403-X) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 7 Arteriogram demonstrates the proximity and frequently similar diameter of the gastroduodenal artery (open arrow) and right renal artery (closed arrow). Journal of Vascular Surgery 1988 8, 154-159DOI: (10.1016/0741-5214(88)90403-X) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions