This article is part of the operation script for grafting an abdominal aortic aneurysm. The article can be used on its own, or to go to the next part of the operation, click on NEXT PART OF THE OPERATION at the bottom of this page.
AORTIC ANEURYSM 270 SECTION 15.00 - MAKING THE VASCULAR TUNNELS
STEP 15.01 INTRODUCTION
- These are retroperitoneal tunnels along which the limbs of the trouser graft will run.
- The peritoneal cover should prevent:
- Adhesions forming between the graft and omentum or bowel.
- Erosion of the limbs of the graft into the bowel.
- The tunnels run from the origins of the internal iliac arteries, round the pelvic brim to the common femoral arteries.
- The tunnels run lateral to the iliac arteries and veins.
- The ureters will run superficial to the tunnels.
STEP 15.02 START MAKING THE LEFT VASCULAR TUNNEL
- Have access to the groins and the abdominal cavity.
- Use index fingers of both hands.
- The right index finger tunnels along the lateral side of the left common iliac artery.
- The left index tunnels up from the lateral side of the common femoral artery.
- The tunnel passes behind the sigmoid colon and the ureter.
- The fingers will meet at right angles due to the curvature of the rim of the pelvis.
- Make sure there are no strands of tissue in the tunnel.
- Using finger dissection will ensure that the diameter of the tunnel is more than 1cm.
- You may not feel or see the ureter during this dissection.
- If the peritoneum tears:
- Repair the defect with eg 3/0 Vicryl once the graft limb is in situ.
STEP 15.03 PASS AN O’SHAUGHNESSY FORCEP UP THE LEFT TUNNEL
- Pass the O’Shaugnessy up the tunnel, pressing on the tip of the forcep on the tip of the index finger inside the tunnel as a guide.
- The closed jaws on the forcep should appear in the pelvic opening of the tunnel.
- Remove the forcep.
STEP 15.04 MAKE THE RIGHT VASCULAR TUNNEL
- Use the same technique as on the left.
- You may need to stand on the patient’s right to do this.
