The inferior mesenteric artery is again reassessed for backbleeding. If there is strong backbleeding, the inferior mesenteric artery is ligated close to the aorta. If the backbleeding is minimal, inferior mesenteric artery is reimplanted by using Carrel patch technique.
Once all the clamps have been released, topical hemostatic agents, such as Gelfoam and thrombin, are placed around the anastomosis to promote hemostasis secondary to needle puncture leaks. Any brisk bleeding is controlled with simple reinforcing sutures using 3-0 polypropylene. A side-biting Satinsky clamp is used for the aortic graft, and the anastomosis is performed with running 4-0 polypropylene suture. At the end of the procedure, 2 ampules of fluorescein dye IV are injected and the perfusion pattern of the bowels is assessed with a Woods lamp.
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