Juxtarenal aortic occlusion

Publisher Summary This chapter describes the operative technique of juxtarenal aortic occlusion. In the Leriche syndrome, progressive atherosclerotic disease involves the origin of the inferior mesenteric artery. It is found that when this artery becomes completely occluded, the clot proceeds up to the level of the renal arteries and this is known as a juxtarenal aortic occlusion. It is necessary to divide the inferior mesenteric vein, avoiding any arterial anastomotic branch. The left renal vein is divided between two arterial clamps and reconstructed later. The upper limit of the dissection is the origin of the superior mesenteric artery, which does not need to be demonstrated. With this extended dissection, it is possible to perform endarterectomy of the aorta and origins of the renal arteries. The clamp is placed across the aorta above the renal arteries. No clamp is required on the lower end. Thrombectomy is performed on the upper part of the aorta. The surgeon's second and third left fingers are applied to the pulsating part of the aorta just beyond the upper limit of the thrombus. It is very important to avoid the plane of thromboendarterectomy, which is too near the exterior of the artery wall, but to use the plane of thrombectomy which leaves enough artery walls behind.