Abstract
When performing high-risk abdominal aortic aneurysm (AAA), aortic cross-clamp time
was reduced to a mean of 9 minutes by performing retrograde anastomosis using a ringed
Y-graft (RYG). Retrograde anastomosis with RYG was performed in nine patients, (eight
men and one woman) with a mean age of 74 years (range: 65–82 years). Three patients
had angina pectoris and chronic renal failure, two had angina pectoris, one had thoracoabdominal
aortic aneurysm and chronic renal failure, one had renal failure, one had aortic regurgitation,
and one had aortic stenosis. First, the right common, external, and internal iliac
arteries were clamped, then, the right limb of the graft was anastomosed to the common
iliac artery or external iliac artery. Next, the aorta and left common iliac artery
were clamped, and a longitudinal incision was made in the aneurysm. The proximal end
of the RYG was inserted into the aorta and blood flow was resumed. Finally, the left
limb of the graft was anastomosed to the left common iliac artery or external iliac
artery. The mean aortic cross-clamp time was 9 minutes (range: 8–18 minutes). There
were no cardiac complications during surgery. The mean operating time was 3:34 hours
(range: 3:05–4:35 hours), and the blood loss averaged 1156 ml (range: 200–2000 ml).
None of the patients developed postoperative complications and all of them have remained
well after discharge. Retrograde anastomosis using RYG is one type of surgery that
could be used in cases of high-risk patients with AAA.
