The IMA orifice was probed and there was found to be moderate back-bleeding. Vigorous bleeding, indicating a robust collateral left colon blood supply, or no bleeding, meaning the left colon was already surviving with no IMA flow, both would obviate the need to reimplant the IMA. Only moderate bleeding indicates possible borderline perfusion, and it was elected to reimplant the IMA.
The external and internal iliac vessels on both sides were clamped and the common iliacs were opened. The aneurysm wall on the right is seen after the mural thrombus was scooped out.
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