Splenorenal arterial anastomoses.

A splenorenal arterial anastomosis may be life-saving or result in renal salvage under a variety of circumstances. These may include thrombosis or aneurysm of the aorta, and obstruction, injury, aneurysm, or anomalies of the renal artery. The successful construction of a left splenorenal arterial anastomosis in a patient with ascending thrombosis of the abdominal aorta is presented. T HE term "splenorenal shunt" has acquired general acceptance as an anasto-mosis between the splenic and renal veins, designed to accomplish portal decom-pression in selected cases of portal hyperten-sion. Little attention has been paid to the unexploited potentialities of the splenic artery as a source of an arterial blood supply to other intra-abdominal viscera. This large artery to an expendable organ has previously been demonstrated to be an adequate replacement for the hepatic, superior mesenteric, or left renal arteries in dogs.' Some of the clinical applications of the splenorenal arterial anas-tomosis in a variety of disease states and an account of the first such operation with a successful outcome in a patient constitute the basis for this report.2 The potential indications for a splenorenal arterial anastomosis are (1) aortic thrombosis (Leriche's syndrome; unresectable); (2) aortic aneurysm; (3) renal artery obstruction; (4) renal artery injury; (5) renal artery aneurysm; (6) anomalous renal artery. AoRTIc THROMBOSIS The treatment of choice for thrombosis of the aorta localized to the region of the bifurcation is resection of the involved segment and replacement with an arterial graft or prosthesis. Significant extension of the thrombotic process either proximally or distally has limited the number of cases suitable for such definitive therapy. Thromboendarterectomy used in conjunction with grafting has not always provided a solution to this problem. lack of an adequate runoff for the flow of aortic blood into the legs, due to obliterative disease extending into the iliac, femoral, and distal arteries, has resulted in thrombosis of grafts.3 On the other hand, ascending aortic thrombosis with eventual involvement of the renal arteries has been observed, with fatalities due to renal failure or with the development of severe hypertension.4-6 A supply of arterial blood to the left kidney from the celiac axis may succeed in obviating or delaying some of these renal catastrophies. CASE REPORT MI. D., MIontefiore Hospital Admission 967213, was a 44-year-old white man with a history characteristic of the Leriche syndrome, consisting of claudication, loss of sexual potency, and absence of pulsations in the lower extremities. A …