Staged retroperitoneal mesenteric revascularisation and aortobifemoral bypass after endovascular rescue for acute mesenteric ischaemia.

ABSTRACT

Visceral artery revascularisation through a retroperitoneal approach provides an infrequent yet viable, alternative means of managing mesenteric ischaemia in patients with previous abdominal operations. We present a unique case implementing this surgical approach in a 55-year-old man in which we performed a retroperitoneal aortobifemoral bypass with concomitant retrograde jump graft from the aortic prosthesis to the superior mesenteric artery (SMA) for bilateral lower extremity rest pain and chronic mesenteric ischaemia. Three months previously, the patient had presented with acute mesenteric ischaemia and colonic perforation. He underwent emergent celiac artery stenting followed by an exploratory laparotomy with total abdominal colectomy and diverting loop ileostomy. Given the patient's hostile abdomen, a retroperitoneal approach to SMA revascularisation was elected over a transabdominal approach during concomitant lower extremity revascularisation for critical limb ischaemia. We achieved an excellent technical result with resolution of limb ischaemia and abdominal symptoms.