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(A) The fourth portion of the duodenum is adherent to the anterior surface of the aorta/graft in the setting of aortoduodenal fistula and should generally be left undisturbed until proximal aortic control can be established. If the endograft does not have a suprarenal component, it is usually possible to obtain aortic control with a vertical suprarenal aortic clamp. (B) Soft jaw aortic clamp (V Mueller, Berlin, Germany).
