Prior ligation of the lumbar arteries at this level facilitates the manoeuvre. Incision in the femoral regions allows exposure of the common femoral arteries. The retroperitoneal tunnels are created by dissecting the proximal iliac arteries laparoscopically, then inserting a large Crawford clamp from the femoral region. Its proximal progression is followed under laparoscopic control. Each limb of the graft is introduced into its respective retroperitoneal tunnel and pulled into the femoral region.
Care is taken to ensure proper placement of the ureters above the limbs of the graft.
After the anastomosis has been tested for leaks, the aorta is again cross-clamped. The animals are observed for 15 minutes after completion of the procedure and are then killed. All animals survived the procedure. Intraoperative blood loss did not exceed 250 mL and was principally due to the flushing techniques used before definitive unclamping. Extra sutures were applied to the aortic anastomosis in two cases because of blood leakage.