John T. Jerius, MDa, Donald A. Elmajian, MDb, David M

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Presentation transcript:

Floppy aortic graft reconstruction for germ cell tumor invasion of the infrarenal aorta John T. Jerius, MDa, Donald A. Elmajian, MDb, David M. Rimmer, MDa, Kevin S. Spires, MDb Journal of Vascular Surgery Volume 37, Issue 4, Pages 889-891 (April 2003) DOI: 10.1067/mva.2003.156 Copyright © 2003 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 1 Abdominal CT scan after three cycles of conventional chemotherapy and one cycle of salvage chemotherapy at the level of the inferior pole of the right kidney demonstrates a 14 cm pseudoaneurysm (arrow) involving the aorta and tumor mass extending to the anterior abdominal wall. Retroperitoneal tumor is still evident. The nonvisualized vena cava is compressed and adherent to the mass. Journal of Vascular Surgery 2003 37, 889-891DOI: (10.1067/mva.2003.156) Copyright © 2003 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 2 Pseudoaneurysm and tumor mass (arrow) are exposed via a left thoracoabdominal incision. Note displacement of the entire small bowel to the right side of the abdomen. Journal of Vascular Surgery 2003 37, 889-891DOI: (10.1067/mva.2003.156) Copyright © 2003 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 3 Floppy aortic graft is in place (small arrow) around the pseudoaneurysm-tumor mass (large arrow), and circulation is reestablished to the pelvis and lower extremities. Journal of Vascular Surgery 2003 37, 889-891DOI: (10.1067/mva.2003.156) Copyright © 2003 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 4 Floppy graft (small arrow) can be manipulated as necessary for retroperitoneal lymph node dissection. Aorta and tumor mass (large arrow) have been completely mobilized on the lateral margins and from the inferior vena cava. Journal of Vascular Surgery 2003 37, 889-891DOI: (10.1067/mva.2003.156) Copyright © 2003 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 5 Floppy graft has been replaced and redundant portions removed. New graft is sewn to cuffs left from the original graft (arrows). Omentum covers the right limb of the graft. Journal of Vascular Surgery 2003 37, 889-891DOI: (10.1067/mva.2003.156) Copyright © 2003 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions