SupraRenal RetroHepatic IVC cross clamping
before en bloc resection of IVC sarcoma and R Kidney.
Spiegel veins divided, blue loop around LRV and distal & proximal IVC.
Subcostal chevron incision, right visceral rotation.
#oncovascular
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Xavier Berard
3,444 posts
Xavier Berard
@XavierBerardMD
Professor of Vascular Surgery, MD, PhD, FEBVS
Bordeaux University Hospital, France
Bordeaux, France
Born August 5
Joined February 2021
- Eagle eye view of the "aortic organ" by thoraco partial phreno lombotomy #aortaEd
00:00 - 2 minutes edited video of SupraRenal aorta endarterectomy and ABI graft by 10th rib thoraco-miniphreno-laparotomy. preop CTA in the tweet quoted Discharged home POD8, asymptomatic with improved renal function. #aortaEd
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00:15A bad scenario for endo. Rest pain, altered kidney function. Mid fifties, ASA3 #aortaEd - Retro pancreatic route for antegrade aorto-SMA bypass for chronic mesenteric ischemia Bi subcostal minilap, proximal anastomosis on supra celiac aorta through lesser omentum, thin wall heparin bonded ePTFE ring graft #vascsurg
00:00 - Retroperitoneal in the morning, Transperitoneal in the afternoon
- Guess what is the aortic problem? It’s not an aortic aneurysm. Preop CTA attached in the thread. Yellow loop for ureters, blue for LRV, reds for left common iliac and Right external & internal iliac arteries. #aortaEd
00:00 - Great team work with 6 open aortic cases this week. Highlight was a type 4 mycotic contained rupture aortic aneurysm. Off pump surgery with clamp and go for thoracic aorta suture then SMA auto shunt from one graft limb by a Pruitt Catheter. #aortaEd
- Type 2 endoleak : surgical treatment for a 17cm aneurysm (BEVAR in EVAR) Midline laparotomy, IMA and multiple lumbar arteries ligation, bacteriology from intraop samples was negative. Patient returned home POD5 Preop CTA in quoted tweet
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00:18Well, The BEVAR looks great but something went wrong below! Tertiary referral for a late seventies patient lost from follow-up after BEVAR in EVAR, dramatic evolution of infrarenal sac, suspected type 2 EL. EVAR 2014 (92mm), BEVAR 2019 (102mm), now AAA diameter is 170mm #aortaEd - 100th open aortic case for 2023. infected ABI graft. Total ABI graft explantation & residual AAA sac resection by infrarenal clamping, in situ repair with antimicrobial graft (transient suprarenal clamp) covered by pedicled omentoplasty.
00:00 - The sub diaphragmatic aorta totally exposed by left visceral rotation. #aortaEd Left kidney is fully mobilized to allow kidney up or down aortic endarterectomy. Aortic coral reef: Hypertension, Chronic Mesenteric Ischemia and CLI
00:00 - Monsieur Aorta, crafted with love just before commando acute case
- A Neo femoral system done with contralateral femoral vein to treat recurrent femoral patch infection in a trido groin. Complete Debulking, Ilio profunda graft with side branch for SFA then sartorius myoplasty. So « NAIS » repair by Benjamin our junior doctor
- SupraRenal AAA, 10th rib left retroperitoneal approach. Red vessel loops on SMA, LRA, a very low RRA and iliac arteries. Clamp above CT #aortaEd
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