Paediatric Vascular Surgery with Total Visceral and Renal Vessel Replacement

An 11 year old boy presented with uncontrolled (four drugs) hypertension due to right and left renal artery (RRA and LRA) stenoses (A, arrowheads). Severe stenoses of the superior mesenteric artery (SMA) and coeliac trunk (CT) were also detected (A, arrows). (B) The right iliac axis was harvested. The common iliac artery (CIA) was anastomosed to the visceral aorta, the external iliac artery to the LRA and the internal iliac artery to the SMA. The CT was re-implanted in the CIA. The RRA was re-implanted into the abdominal aorta with another segment of the external iliac autograft. The iliac axis was replaced with a Dacron graft. EIA = external iliac artery; IIA = internal iliac artery; CIA∗ = additional segment of native CIA to revascularise RRA; BP = bypass synthetic graft.Image 1