There are various ways to perform an aorto-mesenteric bypass. It can be an antegrade bypass from the supraceliac abdominal aorta, or a retrograde bypass from the right (usually) common iliac artery. The graft can be either a synthetic (PTFE, polyester) or venous. Here is the description of a venous bypass originating from the adjacent abdominal aorta.

A patient underwent a Whipple procedure. During the procedure, the superior mesenteric artery (SMA) was accidentally divided. A primary end-to-end repair was attempted by it did not work as the distal part of the SMA presented an intimal dissection. Then an inlay jump-graft was constructed from the proximal part of the SMA to the divided part of the SMA, using a ringed enforced PTFE graft. Unfortunately, it did not work either. Then, a decision for an aorto-mesenteric bypass was made.

The small bowel was rotated towards the patient’s right-hand side. In the root of the mesentery, the distal SMA was found lateral to the superior mesenteric vein. A part of the SMA, about 3 cm long, was dissected free and encircled with elastic vessel loops. Heparin was given IV, and the artery was opened up in a longitudinal fashion on a length of about 2 cm. Then, the adjacent abdominal aorta was identified and dissected free, on a length of about 5 cm. Then, a portion of the right greater saphenous vein of about 12-15 cm long, starting from the saphenofemoral junction was taken.

An anastomosis of the graft was made from the abdominal aorta to the SMA. The graft was oriented on a reversed configuration. Initially, the distal anastomosis was made with a 6/0 Polypropylene suture, in a parachute fashion. Then, the proximal anastomosis of the graft to the abdominal aorta was made using a 4/0 Polypropylene suture, again in a parachute fashion. The final view of the graft can be seen in the pictures below.