A new technique for intra-abdominal arteries revascularization via extra-anatomic bypass from the brachiocephalic artery with a videoscopic retrosternal.

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Presentation transcript:

A new technique for intra-abdominal arteries revascularization via extra-anatomic bypass from the brachiocephalic artery with a videoscopic retrosternal tunnel Isabelle Javerliat, MD, Audrey Pichon, MD, Matthieu Glorion, MD, Raphaël Coscas, MD, Olivier Goëau-Brissonnière, PhD, Marc Coggia, MD Journal of Vascular Surgery Volume 62, Issue 1, Pages 256-258 (July 2015) DOI: 10.1016/j.jvs.2015.02.032 Copyright © 2015 Society for Vascular Surgery Terms and Conditions

Fig 1 Perioperative view from the left side of the patient, who is in a dorsal decubitus position, with the operator standing on the right side. The 7-mm endoscope (E) with the clear cone-shaped tip is prepared to perform the retrosternal tunnel. A right cervicotomy (C) has been created, with the head (H) slightly turned to the left. Journal of Vascular Surgery 2015 62, 256-258DOI: (10.1016/j.jvs.2015.02.032) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

Fig 2 Perioperative view from the left side of the patient. A retrosternal tunnel is performed between the laparotomy and the right cervicotomy under videoscopic control, and the endoscope is externalized at the right cervicotomy. The endoscope light (*) is seen in the cervicotomy. H, Head. Journal of Vascular Surgery 2015 62, 256-258DOI: (10.1016/j.jvs.2015.02.032) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

Fig 3 Perioperative zoom on the right cervicotomy (C) shows the distal extremity of the endoscope, with its clear cone. The head (H) turned slightly to the left. SCM, Sternocleidomastoid muscle. Journal of Vascular Surgery 2015 62, 256-258DOI: (10.1016/j.jvs.2015.02.032) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

Fig 4 Perioperative view from the right side of the patient. The 10-mm prosthesis is tunneled behind the sternum, from the cervicotomy (C) to the abdomen (A), before performing the proximal anastomosis on the brachiocephalic artery (BCA). Journal of Vascular Surgery 2015 62, 256-258DOI: (10.1016/j.jvs.2015.02.032) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

Fig 5 The proximal anastomosis of the 10-mm graft (&) has been implanted on the brachiocephalic artery (BCA) before unclamping. Clamps are positioned on the BCA (1), on the subclavian artery (2), and on the common carotid artery (3). The patient's head is located under the blue swab. *, Sternal notch; ¤, right common carotid; L, left part of the thorax; R, right part of the thorax; S, sternum. Journal of Vascular Surgery 2015 62, 256-258DOI: (10.1016/j.jvs.2015.02.032) Copyright © 2015 Society for Vascular Surgery Terms and Conditions