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Aortic Clampless Technique in Open Revascularization of Acute Mesenteric Ischemia
Odeaa Al Jabbari, Walid Abu Saleh, Matthew Bennett, Mahesh Ramchandani, Alan B. Lumsden
Houston Methodist Hospital, Houston, TX

Objective:
Abdominal aortic cross clamping results in increased risk of postoperative morbidity but is required in many visceral bypass operations. The PAS-Port Proximal Anastomotic System, originally developed for coronary artery bypass grafting, creates sutureless proximal aortic anastomoses without the need for cross clamping, but its use elsewhere in the body has not been reported.

Method:
Between December 2014 and March 2015, five patients presented to our institution with abdominal pain which represented mesenteric vessel stenosis. three patients had stenosis of the celiac artery and the other two had stenosis of the superior mesenteric artery. The mean age for the patients was 64 years (46 - 75). The patient group included three males and two females. The mesenteric revascularization surgery was performed using the PAS-Port Proximal Anastomotic System. The technique used is described as follows:

The great saphenous vein was harvested. A midline laparotomy from the xiphoid to below the umbilicus was performed. The triangular ligament was divided to allow the left lobe of the liver to be retracted laterally. The aorta was exposed below the level of the diaphragm. The fibers of the median arcuate ligament were divided. The bypass from the supraceliac aorta to common hepatic artery was performed in three patients and in the other two patents to the SMA. The proximal anastomosis was created using the PAS-Port and an end-to-side anastomosis distally.

Results:
The average operative time was 3.15 hours (3-4). The average estimated blood loss was 415 cc (200 - 500). No aortic clamp was used. One patient received 1 unit of blood during surgery. There was no anastomotic bleeding. The average ventilation time was 6 hours (3-9). The average length of stay in the ICU was 24 hours (23-52). The average length of stay in the hospital was 7 days (6-9) with no complications; all patients experienced resolution of their symptoms.

Conclusions:
Use of the PAS-Port Proximal Anastomotic System in the abdominal aorta is a viable alternative to traditional anastomotic techniques. The device reliably creates a proximal anastomosis without the need for aortic cross-clamping. Use of the device did not cause any complications and the anastomoses created have good initial patency. Use of the PAS-Port can extend the option of mesenteric bypass to patients otherwise unable to undergo aortic cross-clamping.


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