Figure 3.

Reconstruction with an aorto-bi-iliac antimicrobial graft. (A) Sketch of the aortic reconstruction, always recorded in the patient's files: (1) left thoracorenal bypass using a 7 mm diameter antimicrobial graft to limit left renal warm ischaemia time to 25 minutes; (2) cross clamping of the thoracic aorta above the coeliac trunk and below the thoraco-renal bypass to perform complete excision of grafts and debridement of devitalised tissue while perfusing the right kidney using a 4°C Ringer lactate solution. In situ reconstruction with a bifurcated antimicrobial graft of 20/10 mm in diameter sutured below the superior mesenteric artery, with a warm ischaemic time of 30 minutes for the coeliac trunk and superior mesenteric artery; (3) direct re-implantation of the right renal artery into the main body after one hour of cold ischaemia; (4) distal anastomoses on both external iliac arteries. (B) Proximal aortic anastomosis performed below the superior mesenteric artery and the coeliac trunk (identified with the two upper red silastic slings) but above the renal arteries, using an antimicrobial bifurcated graft. (C) Cross clamping of the right renal artery just before performing its re-implantation. (D) Re-implantation of the right renal artery to the main body of the aortic graft.