Clinical use of the seromuscular jejunal patch for protection of the infected aortic stump

Abstract

Pathologic interactions between aortic prostheses and the gastrointestinal tract are very difficult problems in vascular surgery. After excision of the graft and proximal aortic closure, the major unsolved problem has been continued sepsis of the proximal aortic stump with subsequent fatal disruption. To provide healthy tissue for protection of this crucial area, we have devised a method in which a piece of jejunum on its vascular pedicle is opened along its antimesenteric border, the musosa is removed, and the vascularized muscular wall is anchored to the aortic stump. This seromuscular jejunal patch was used clinically in three patients. Postmortem examinations in two of these patients 4 and 45 days postoperatively revealed no signs of infection, hematoma, or mucocele, and no histologic abnormalities; instead, the examinations did reveal firm tissue adherence between the aortic stumps and the seromuscular patches. The third patient is alive and well 1 year after this procedure. The three patients have demonstrated the feasibility of secure aortic stump protection by placement of well-prepared, vascularized seromuscular jejunal tissue over the potentially infected aortic stump. This technique may prevent postoperative stump dissolution and thus far appears to be a reasonable solution to this usually lethal problem.